vol.28 no.5 • May 2020
repertoiremag.com
Supply chain leaders meet with the president pg.46
Plus inside:
Excellence in Sales
Claire Bishop
Stacy Comb
STRONG TOGETHER TODAY... STRONGER TOGETHER TOMORROW The COVID-19 pandemic is our generation’s most severe healthcare challenge. We are so grateful to our healthcare professionals who selflessly put themselves out there every day to care for our citizens. You are truly heroes. We also thank our distribution partners who provide the essential products to those professionals. We are here to support all of you in any way possible. Our employees are committed to maintaining business continuity and manufacturing during this time to continue to provide the diagnostic tools they need. Sekisui Diagnostics is here for you because we understand every result matters. We will get through this, together.
BOB SCHRUENDER PRESIDENT AND CEO
LEE LIPSKI SR. VP & GENERAL MANAGER, IVD BUSINESS UNIT
MAY 2020 • VOLUME 28 • ISSUE 5
Stacy Comb
Claire Bishop
Excellence in Sales
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Repertoire recognizes two people – one from the distributor side, one from the manufacturer side – as this year’s recipients who embody that excellence.
PUBLISHER’S LETTER Proud of our industry....................4
PHYSICIAN OFFICE LAB Specialty testing opportunities POL testing is a critical component of patient diagnosis and management........6
Lab/diagnostics: Talking points................................... 12
TRENDS MRSA: Still a threat...................... 30
Sales
A systematized approach to selling 7 smart ways for healthcare sales reps to build trust and credibility with healthcare providers
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Physicians catching on to digital health tools......... 34
repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2020 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.
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MAY 2020 • VOLUME 28 • ISSUE 5
IDN OPPORTUNITIES
Tony Johnson
Jeromie Atkinson
More supply chain ripple effects to come At an inflection point, why the supply chain must rise above ‘every man for himself ’ type behaviors...... 42
SMART SELLING
IDN Opportunities
Staying strong during the COVID crisis.............48
HEALTHY REPS Health news and notes...............50
Bold steps How this year’s Contracting Professional of the Year led his organization’s supply chain through a transformation – and realized $92 million in value during the past fiscal year – by moving to a more strategic model
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Distribution
Come Together Supply chain leaders met with the president at the White House as part of the COVID-19 Supply Chain Task Force
Quickbytes
Technology news
52
INDUSTRY NEWS Tim Dungey: ‘Exceptional leader, and an even better person’...................... 55 News ........................................................56 2
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Windshield Time
Automotiverelated news
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PUBLISHER’S LETTER
Proud of our industry Three weeks into social distancing and so much has changed in our world. By the time
you read this, our world will have changed even more. As I write this, it appears New York is making the turn to recovery, and shockingly the media is beginning to say positive things, which gives me hope. I just saw the first political ad for president in three weeks, which tells me we’re back on the mend. Our industry is in the eyes of the world right now, and the collaboration between distributors and manufacturers has been incredible to watch. From seeing the national distribution five CEOs with POTUS to hearing stories of entire physician offices giving standing ovations to distribution drivers, it is such an honor to serve in this space. Thank you to every one taking care of the providers. The work you’re doing is incredible.
Scott Adams
It will be so interesting to see how history records this time. Here are a few funny thoughts to hopefully brighten your day: ʯ 6 feet of separation. ʯ POTUS and Cuomo press conferences – I’d rather go to the dermatologist than watch another ʯ Don’t make eye contact with anyone at the one of either (No offense to the Derms). grocery store. ʯ Toilet paper (enough said). WTH people? ʯ We have either lost 10 pounds or gained 15. ʯ Zoom Meetings. ʯ No sports! ʯ Zoom Happy Hours, or as I like to say ʯ Text threads with more people than you thought #ItsZoomO’clockSomewhere you knew. ʯ How many extra bottles of Titos you’ve stocked ʯ Just wanting to sit in a restaurant. up on says you might have a problem. ʯ No haircuts. I could go on, but it would probably go downhill from here. I do believe this time of being still at home with family has had many positive effects on us all. It’s also given us time to reflect on what is truly important. I miss seeing my med-surg family and hope you are all staying safe. Dedicated to the industry, R. Scott Adams PS: Please be sure you are signed up for the dail-eNews and checking the Repertoire website regularly. We are developing content about you and for you every day. Our goal is to be a ray of light keeping us all connected.
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
editorial staff editor
Mark Thill
vice president of sales
Katie Educate
keducate@sharemovingmedia.com (800) 536.5312 x5271
mthill@sharemovingmedia.com managing editor
Graham Garrison ggarrison@sharemovingmedia.com editor-in-chief, Dail-eNews
Daniel Beaird dbeaird@sharemovingmedia.com art director
Brent Cashman bcashman@sharemovingmedia.com
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publisher
Scott Adams sadams@sharemovingmedia.com (800) 536.5312 x5256 founder
Brian Taylor btaylor@sharemovingmedia.com circulation
Laura Gantert lgantert@sharemovingmedia.com
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2020 editorial board Richard Bigham: IMCO Eddie Dienes: McKesson Medical-Surgical Joan Eliasek: McKesson Medical-Surgical Ty Ford: Henry Schein Doug Harper: NDC Homecare Mark Kline: NDC Bob Ortiz: Medline Keith Boivin: IMCO Home Care
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PHYSICIAN OFFICE LAB
Specialty testing opportunities POL testing is a critical component of patient diagnosis and management Inflammation, infection and tissue damage is a common cascade of events in the presence of
By Jim Poggi
many diseases. Sometimes the initial inflammation can be subtle and provide no overt symptoms until the underlying condition is well advanced. Gingivitis and certain heart conditions come to mind. Internal infections including H. pylori also fall into this category. Autoimmune diseases and arthritis typically present as inflammation initially.
In this month’s article, I will review some of the common tests available today to help diagnose these conditions and to provide laboratory information to shorten the course of the disease and improve patient outcomes. For diagnosis of these conditions, with the exception of acute myocardial infarction (heart attack), testing at the point of care is the first line of defense and 6
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POL testing is a critical component of patient diagnosis and management. When the body comes under attack from viruses, bacteria, or other foreign agents, there is a pretty typical cascade of events. First, there is an inflammation of the affected tissue. In the early going, it may remain subclinical with no apparent symptoms. The affected tissue does
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PHYSICIAN OFFICE LAB not usually become distended, warm to the touch or have other obvious symptoms. This is especially true of internal infections, including arthritis and autoimmune diseases where the source of the inflammation is less apparent. Over time, inflammation commonly turns to infection, further impacting the tissue under attack. Finally, under extreme conditions, the muscle dies. Endocarditis and ischemic heart disease often result in damage to the heart muscle.
Inflammation markers C-reactive protein (CRP) is a common screening test performed to rule out inflammation and is also often used as a first screen for arthritis, either alone or in combination with rheumatoid factor (RF). While it is highly sensitive, it is not a specific indicator of a specific disease. As a result, a screening positive result on CRP will lead to further tests including erythrocyte sedimentation rate (ESR), CBC, autoimmune tests including RF, antinuclear antibody (ANA) and others. There are multiple CRP methods available, ranging from simple latex agglutination slide tests to meter based tests all the way up to chemistry instruments. The range of expected values for quantitative tests is from 0.8 to 10 mg/L with most experts considering a level above 3 mg/L as abnormal. High level CRP tests have become widely available on a number of chemistry systems, and are more commonly used in diagnosis of heart disease. Typical reference range is between 0 and 3 mg/L with levels above 1.0 mg/L considered abnormal. Both CRP and hs-CRP tests are CLIA moderate complexity.
Untreated infections as well as acute myocardial infarction (heart attack) can result in sudden, acute muscle damage. Rapid diagnosis and initiation of an appropriate treatment plan are critical steps to reduce the amount of muscle lost and, in the case of heart muscle, retain reasonably normal heart function.
Infection markers An elevated CRP test is typically the gateway to further lab testing to pinpoint the underlying condition and initiate an appropriate treatment protocol. ESR testing often accompanies CRP and is also a non-specific indicator of infection. Reference ranges vary between genders and increase 8
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with age. Women tend to have higher ESR values than men irrespective of age. ESR is also moderate complexity and both manual and automated test methods are available. When differential diagnosis of infection is warranted, a complete blood count with specific attention paid to WBC count and WBC differential results is a classic follow up to CRP or ESR. We’re all familiar with the range of hematology systems available, ranging from even waived systems to automated hematology systems with 5-part differentials and specialized hematology parameters, including monocyte distribution width, which has recently been shown to have diagnostic value for sepsis and reticulocytes. Due to their versatility, they play a key role in diagnosis of diseases ranging from infection, anemia, bleeding disorders and cancer. Getting to know your hematology suppliers and their
PHYSICIAN OFFICE LAB products well is an excellent strategy to grow your lab business and build long standing customer relationships. Sepsis is sometimes first encountered in primary care, but is rapidly escalating to tertiary care centers, usually through the ER. In the specialized world of diagnosis of sepsis, procalcitonin, lactate and monocyte distribution width are common follow up tests used to aid in the diagnosis and lead to treatment plan initiation.
Muscle damage markers Untreated infections as well as acute myocardial infarction (heart attack) can result in sudden, acute muscle damage. Rapid diagnosis and initiation of an appropriate treatment plan are critical steps to reduce the amount
of muscle lost and, in the case of heart muscle, retain reasonably normal heart function. While muscle damage markers are typically performed in the tertiary care hospital setting, the urgent care and free-standing ER customers we call on also see patients presenting with symptoms that may require muscle damage tests. The time-honored test to diagnose heart attack is CK-MB. In health, CK-MB levels are undetectable. For diagnosis of heart attack, it is typically used in combination with its parent enzyme, CK. When an elevated CK-MB along with a CK-MB:CK ratio of 2.5-3.0 is encountered, heart attack is a probable diagnosis. Troponin I and T (two different assays) are newer methods to diagnose heart attack and acute coronary syndrome (insufficient blood flow to the heart). Range of expected values for Troponin I is 0.0 to 0.04 ng/ml. Values above this level indicate a possible heart attack. Recently high sensitivity Troponin tests have entered the market. They are believed to be even more useful for acute coronary syndrome in particular due to their higher sensitivity. The range of expected values for hs-TnI is 0.0 to 0.14 ng/l. Troponin is CLIA moderate complexity and typically performed on immunoassay instruments. The last muscle damage marker for this discussion is lactate dehydrogenase (LD). It is elevated when damage occurs to a number of organs including the heart, liver and kidneys, and can also be elevated in sepsis or certain anemias. The range of expected values for LD decreases with age and is less than 40 U/L in adults. It is CLIA moderate complexity and typically performed on chemistry systems. Since it is not as specific as other organ damage markers, it is often performed with other tests including liver enzymes (ALT, AST) and comprehensive metabolic panel to try to identify the organ with damage. Knowing some of this important clinical information helps keep you in the know as a solid consultative resource for your customers. Use it wisely and good luck.
C-reactive protein (CRP) is a common screening test performed to rule out inflammation and is also often used as a first screen for arthritis, either alone on in combination with rheumatoid factor (RF). While it is highly sensitive, it is not a specific indicator of a specific disease. As a result, a screening positive result on CRP will lead to further tests.
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LAB DIAGNOSTIC NEWS
Lab/diagnostics: Talking points Did laboratory testing ever hold a higher profile among the public than it did in late winter with COVID-19?
Maybe not. But despite the focus on COVID-19, other lab-related news of interest to Repertoire readers and their customers continued to unfold.
Blood biopsies, molecular diagnostics and artificial intelligence are just some of the technologies shaping the future of diagnostics. Some have found their way into the physician’s office; others will follow. In either case, here are some recent developments for sales reps to keep in mind on their calls.
Can’t. Stop. Testing. Ask your physician customers: “How often do you find yourself ordering follow-up tests or even procedures following incidental findings, that is, findings unrelated to the primary objective of the screening or diagnostic test?” Now ask, “How many of those follow-up tests fail to turn up anything of clinical importance to the patient – 12
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or worse, cause some kind of harm to the patient from a physical, financial or emotional perspective?” According to a study published in October 2019 by JAMA Network, the answer is “Many.” Among 376 practicing U.S. internists in a nationally representative survey study, most reported that they had experienced or initiated so-called “cascades” after incidental findings that failed to lead to clinically important and intervenable outcomes yet caused harm to patients and themselves. Such cascades commonly included telephone calls with patients (21.7% reported them at least weekly), new noninvasive tests (16.1% at least weekly), and repeated tests (14.7% at least weekly). In addition, most physicians had experienced a cascade for their patient that led to a
new invasive test (77.2%), emergency department visit the possibility of incidental findings and potential courses (54.8%), or hospitalization (50.6%). of action even before ordering a test. Physicians reported cascades caused their patients Colorectal cancer and younger individuals psychological harm (68.4%), physical harm (15.6%) and The burden of colorectal cancer is swiftly shifting to financial burden (57.5%), and caused the physicians younger individuals. In fact, half of all new diagnoses are wasted time and effort (69.1%), frustration (52.5%), and in people 66 or younger, according to Colorectal Cancer anxiety (45.4%). When asked about their most recent cascade, 33.7% of the respondents said the test revealing the incidental finding may not have been clinically appropriate. During their most The zig and zag of COVID-19 testing recent cascade, physicians reported that guidelines for follow-up testing Crazy times in the final month of winter were not followed (8.1%) or did not After a botched early attempt by the Centers for Disease exist to their knowledge (53.2%). Control and Prevention to produce and disseminate testing What does the future hold? COVID-19 kits early this year, the agency regained its balAlthough only 19.9% of physicians ance and corrected the problem. In February, the U.S. Food reported that they ordered follow-up and Drug Administration issued guidance to accelerate testing because their patient asked the availability of COVID-19 diagnostic tests developed by for it, the researchers expect patients laboratories and commercial manufacturers during what the to have a bigger role in testing in the Secretary of Health and Human Services called a “public health future as they gain increased access emergency.” In mid-March the FDA said it would allow individual to laboratory and radiology results states to authorize the use of laboratory-developed tests by qualithrough electronic portals. fied in-state labs without applying with the FDA for an “Emergency And the solution? Use Authorization,” or EUA. Almost 63% of the physicians believed that accessible guidelines Diagnostics companies and reference labs responded rapon how to manage incidental findidly with tests to be performed in high-complexity CLIA labs. ings would help limit the negative They include: consequences of cascades, 48.1% ʯ Hologic: Panther Fusion SARS-COV-2 Assay. said patient and clinician education ʯ Laboratory Corporation of America (LabCorp): on potential harms from unnecesCOVID-19 RT-PCR test. sary medical care would help, 44.6% ʯ Roche: cobas SARS-CoV-2 test. identified decision aids (i.e., shared ʯ Qiagen: QIAstat-Dx Respiratory 2019-nCoV Panel decision-making tools for physician ʯ Thermo Fisher Scientific: Applied Biosystems TaqPath Assay and patient), and 42% chose malʯ Quidel Corp: Lyra® SARS-CoV-2 Assay. practice reform. (Of the almost oneʯ Abbott Molecular: RealTime SARS-CoV-2 assay fifth of responding physicians who ʯ Quest Diagnostics: SARS-CoV-2 RNA, Qualitative reported personal experience of a Real-Time RT-PCR medical malpractice lawsuit, 11.4% said they had been sued for failing to In late March, two companies – EverlyWell and Nurx – follow up on an incidental finding.) announced the availability of at-home COVID-19 diagnostic Much fewer thought that patient tests. And on March 21, the FDA granted “emergency use cost-sharing (18.1%) or value-based authorization” to Cepheid for the first point-of-care coronavipayment models (16.2%) would help. rus test … just as questions were being raised about the value The researchers believe the of testing the public as a strategy to contain the outbreak! results of their study highlight the importance of patient engagement, including talking to patients about www.repertoiremag.com
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LAB DIAGNOSTIC NEWS Statistics 2020, a publication of the American Cancer Society. Put another way, the median age of diagnosis has dropped from age 72 in 2001-2002 to age 66 during 2015-2016. Colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer death in both men and women in the United States. Rapid declines in CRC incidence occurred in people 50 and older during the 2000s, largely because of increased screening with colonoscopy, which can prevent cancer by removing premalignant polyps.
laboratory providers and clinical laboratory societies have announced a new collaboration intended to make it easier for primary care physicians to determine if an at-risk patient has kidney disease. The organizations have recommended a new test profile – a so-called “Kidney Profile” for CKD assessment and diagnosis. The profile follows evidence-based clinical practice guidelines, which recommend two tests for CKD assessment: the estimated glomerular filtration rate (eGFR), which assesses kidney function; and urine albumin-creatinine ratio (ACR), which assesses kidney damage. Both are used to test for and diagnose CKD in primary care settings. Laboratories adopting the “Kidney Profile” will simplify ordering of the tests needed to detect and diagnose CKD by pairing them together under one heading on the laboratory requisition form or electronic health record order. Such streamlining of CKD test ordering could help to eliminate the need to search for each test separately and increase the ease of monitoring results. The “Kidney Profile” also makes it easier for people at risk for CKD to better understand and track their health.
Your odds of ischemic stroke
“Timely diagnosis among young patients remains critical while we await answers to why CRC incidence is rising in young and middle-aged adults,” Rebecca Siegel, MPH, lead author of the report, was quoted as saying.
The ‘Kidney Profile’ More than 30 million Americans are estimated to be living with chronic kidney disease, but only about 3.6 million are aware they have it, according to the American Society for Clinical Pathology (ASCP). Now, ASCP, the National Kidney Foundation and a group of 16
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In the future, with just one blood draw, providers may be able to identify people at a particularly high risk of ischemic stroke, the most common kind of stroke, reports Cardiovascular Business News. By knowing their “genetic risk score,” patients can manage their risk factors earlier and more effectively, according to researchers from the Baker Heart and Diabetes Institute in Australia and the University of Cambridge in the U.K., who reported their findings in “Nature Communications.” The teams employed machine learning to integrate stroke-related genetic data from a variety of research projects, then tested the model in a population of 420,000 individuals enrolled in the UK Biobank. Using the score, they could detect the roughly one in 400 individuals at a threefold risk of ischemic stroke, which occurs when a vessel supplying blood to the brain is obstructed.
Excellence in Sales What is excellence in sales? Numbers help, for sure. But every Repertoire reader knows it’s more than that. It’s that
drive to get better, to help people, to have an impact on something meaningful. More often than not, it’s also fun. This year, as we have since 2000, Repertoire recognizes two people – one from the distributor side, one from the manufacturer side – who embody that excellence. See if you can’t find something of yourself in their stories.
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Distributor
Manufacturer
2020
Stacy Comb, Claflin Company
Claire Bishop, Quidel
2019
Jarrel Watkins, McKesson
Stephen Raggio, Welch Allyn
2018
Mike McGoldrick, Henry Schein
Dianna Hundl, Quidel
2017
Victor Bakkar, McKesson Medical-Surgical
Patrick Thombs, Clorox Healthcare
2016
Mike Ludwig, Henry Schein
Chris Huppert, Midmark
2015
Todd Matthews, McKesson Medical-Surgical
Nick Riordan, Welch Allyn
2014
Chuck Ryan, McKesson Medical-Surgical
Nate Williams, Midmark
2012
Paul Lilly, McKesson Medical-Surgical
Louis Cupo, Cardiac Science
2011
KC Meleski, Claflin Equipment
Mimi Hobson, Terumo
2010
Steve Marshall, Cardinal Health
Mike Paige, Med Care Associates
2009
Rich Bilz, Henry Schein
Tommy Whitehead, Midmark
2008
Tom Jacob, McKesson Medical-Surgical
Denny Monnin, Midmark
2007
Dick Daley, Affiliated Healthcare Systems
Bob Chaldu, TIDI Products
2006
Mike Leva, Claflin Company
Jack Moran, Med Care Associates
2005
Marty McCurdy, PSS
Steve Bakalar, Welch Allyn
2004
Denise Hassler, Caligor
Jeff Daner, Midmark
2003
James Barnes, Cardinal Health
2002
Jim Wheeler, Seneca Medical
2001
Linda Phillip, McKesson Extended Care
2000
Brad Jacob, McKessonHBOC
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Excellence in Sales It had to be sales Stacy Comb + medical sales = a perfect fit The medical sales profession attracts people for all
kinds of reasons. Take Stacy Comb, account manager for Warwick, Rhode Island-based Claflin Company. When she was a kid, Comb had an experimental outpatient heart procedure at Boston Children’s Hospital. “I was able to have a problem corrected in one day that historically required open heart surgery and a long recovery period,” she says. “Since then, I have always had a passion for the medical field, learning about new procedures and products, and getting the word out to customers.”
is a waitress, and her father, Mark, a retired union glazier (that is, an installer and remover of glass from buildings). Together, they provided their daughter a model for a successful career and approach to life. “Both of my parents worked long hours doing physical jobs, and they were tired when they got home!” she says. “But they made sure we always had food on the table and presents under the Christmas tree, and they always taught me the value of a dollar. “I could see that it was a struggle for them at times. They didn’t want that for me, and I didn’t want it for myself. They’re very proud that I’m a first-generation college graduate, but if it weren’t for their hard work and guidance, it may not have happened.”
Cold calls and copiers After graduating with a bachelor’s degree in communications from the University of New Hampshire in 2003, Comb took a job selling copiers. “It was the quintessential sales job to gain experience. I made it through a year of cold calling and lots of rejection and came out stronger on the other side.” Two years later, she became an outside sales rep for Paychex, an outsourced payroll and HR solutions company. At Paychex, she called on prospective customers and built a referral network of accountants, attorneys, bankers, and insurance agents. “My customers had anywhere from one to 50 employees, ranging from pizza shops to daycares to law firms. No two days were alike. It was fun!”
Stacy Comb
Add to that a built-in love for sales and an interesting mixture of sales jobs, and you have this year’s distributor recipient of the Repertoire/HIDA Excellence in Sales Award. Comb was born and raised in Burlington, Massachusetts, about 15 miles north of Boston. Her mother, Joan, 20
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After five years in sales, Comb knew the profession suited her well: ʯ Sales allowed her to be in charge of her own destiny. ʯ Sales gave her the freedom to work with people to find solutions to their needs – something she enjoys. ʯ Sales let her be on the move. “I have too much energy to sit still for too long,” she says.
Pivot to medical In 2008, she joined Covidien (now Medtronic), selling patient care products in such categories as wound care,
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Excellence in Sales incontinence, enteral feeding and urology. Her call points included supply chain, infection control, wound ostomy, nutrition and value analysis. Five years later, Comb decided that working for a distributor might make her more well-rounded in the healthcare supply chain. She was attracted to Claflin, which was her main distributor while at Covidien. “The culture of the company, the way they serviced their hospitals, and the relationships that they had built with their customers was impressive,” she says. Today, as Comb calls on health systems in southern Massachusetts and Rhode Island, she continues to learn new things about the profession she loves.
Influence on product selection
helps to form a brand for the hospital, and supply chain plays a part in that.” By participating on value analysis committees at several health systems over the years, Comb has become a trusted resource, and a student of IDNs’ decision-making processes. “It’s interesting to see how differently [value analysis] is handled from system to system,” she says. “The best value analysis groups that I have been a part of have a sufficient – but not excessive – number of people involved, who are committed to meeting on a regular schedule and staying on task between meetings. With all of the supply chain disruptions that we are seeing in the industry, being able to come to a decision in a shortened time frame is more important than ever.”
For example, “While it’s true that purchasing decisions are often The best of the best driven by GPO contracts, there is To become valuable resources to still plenty of room for a distributheir customers, sales reps need to tor account manager to have influshare information, provide solutions ence on product selections,” she Stacy and her family. and stay in touch, says Comb. says. “GPO contracts can be dual “With the increasing product or multisource, leaving the hospital ‘My customers had shortages caused by sterilization with options while still being able to take advantage of GPO benefits, anywhere from one issues, consolidations, recalls, and most recently, COVID-19, comincluding rebates. Alternatively, if to 50 employees, munication has never been more you can show enough combined clinical and financial benefit with ranging from pizza important. Bad news does not get better with age, so when a disruption a product or product group that is shops to daycares occurs, hitting it head-on is critical.” off GPO contract, I’ve never had a And in today’s digitized world, customer unwilling to at least give to law firms. No two in-person contact remains essenit consideration.” days were alike. tial, she says. “Emails can get lost or Patient satisfaction is another facIt was fun!’ misinterpreted, and they aren’t very tor that is influencing IDNs today, she personal. At the end of the day, it’s adds. “Boston is known for its world important to have a good working class hospitals. Patients have options and personal relationship with your customers, so that in choosing where to go to receive their healthcare. The when tough situations arise, you can work it out together best supply chain organizations are looking for ways to – because you have learned to like each other.” improve a patient’s experience. Comb and her husband, Brad (who sells SAP soft“It’s not just by giving out welcome or quiet kits – ware), have been married four years. With their daughter, though these are nice. It’s about considering the quality Allie, they live in Scituate, Massachusetts, on the South and associated outcomes of products that are chosen for Shore of Massachusetts, enjoying boating and the beautiuse in the hospital, in addition to the cost. Infection rates, ful beaches there. satisfaction scores – this is public information which 22
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Excellence in Sales
Stacy Comb: Word’s out Comments from co-workers and customers. “ Stacy goes above and beyond in the name of patient care and South Shore Health, and she represents her company, Claflin, with unmatched professionalism and service. There are not enough words to name examples of her excellence. I have worked with numerous distribution companies, and they all have their challenges, but what Stacy does for Claflin is an enormous difference maker. I dread the day she is promoted!”
“ Stacy has remained very professional and helpful during some of our most challenging moments as an organization. These past few months, we have been in transition to a new ERP system, and Stacy has remained available during a time of change and complexity. She has been instrumental in coordinating with customer service and is a pleasure to work with.”
– Nicholas Seremetis, director of supply chain, South Shore Health, South Weymouth, Massachusetts
“ Stacy is a dedicated account manager who has excelled in her role. She is always available when needed, takes that extra step to ensure your needs are met, and when there is an issue, she responds quickly with a resolution.”
“ Stacy has been a tremendous asset to our workplace. She is there in a pinch in times of recalls or product issues.” – Sean Fitzgerald, supply chain manager, New England Baptist, Boston, Massachusetts
“ Stacy’s customers are large IDNs, and they rely on Stacy as an extension of their supply chain team. Some hospitals even give her the same credentials as their employees. She is part of many value analysis teams at her key accounts to help with product conversions and or make suggestions for better outcomes. She is well versed in CQO [cost/ quality/outcomes], and they look to Stacy for guidance from the distributor’s point of view. In the midst of many product interruptions, Stacy takes it upon herself to come to the office and pick up product to offer a substitute, so the customer doesn’t miss a beat.” – Alex Caldwell, vice president sales and marketing, Claflin Company
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– Kevin Burgos, operations supervisor, South Shore Health
– Anthony D’Allessandro, manager of distribution and logistics, South Shore Health
“ Stacy is a consummate professional who always puts her customers’ needs first. Some of her attributes include persistence, conscientiousness, attention to detail, respectfulness and industry knowledge. She is a valuable resource to her customers and the Claflin Company.” – Michael Leva, director of business development, Claflin Company
“ Stacy understands the customer needs and how best to help them through many different situations. She is attentive and responsive.” – Meaghan Almon, sales representative, Claflin Company
Proud namesake Quidel’s Claire Bishop glad to carry her grandmother’s name Claire Elliott, M.D., was the first woman in the United
States to be invited to attend two medical schools. She earned board certification in three fields of pathology, and served as an advisor to the Alabama Department of Environmental Management. She passed away two years ago. “She was a strong leader in her time, and it is an honor to carry on her name,” says her granddaughter and namesake Claire Bishop, hybrid account manager for Quidel in Washington, D.C., and the 2020 manufacturer recipient of the Repertoire/HIDA Excellence in Sales Award. Bishop was born and raised in Birmingham, Alabama, and got a bachelor’s degree in business administration with a concentration in marketing and computer science from the University of Alabama. After graduating, she took an account manager job with Pitney Bowes, the Stamford, Connecticut-based shipping, e-commerce and financing firm.
“I learned how to identify customers’ true priorities, navigate complex sales faster, and engage confidently as a trusted advisor rather than as ‘just a salesperson.’ It changed how I viewed the sales process, and I still use these skills every single day.” In September 2017, she joined Quidel.
Learning curve “It was my first shot at managing a geographical territory as an outside rep,” she says. “Everything was new to me. I gained the independence that allowed me to learn what works best for me and gave me the autonomy to take risks, learning from my mistakes. I gained valuable knowledge of how to manage my time effectively and to hit a monthly sales goal.” After two years at Pitney Bowes, Bishop joined Abbott to begin her career in diagnostic equipment sales. Despite the fact that she hadn’t any previous experience in medical sales, her manager knew she could handle it. “He distinctly remembers my interview, when he asked what made me successful. My answer was simple: ‘They require us to make eight calls a day; I make 16. I work longer and harder than my competition.’” With her new position came a learning curve about medical technology, distribution and the industry itself. It also came with what she considers some of the most valuable sales training of her career, from Simon Letchford, who at the time was CEO of Scotwork North America, a firm specializing in negotiation training and consulting. (Today he is CEO of Swagger Sales in New York City.)
Claire Bishop
Industry lessons In 2018, when Bishop was featured as one of Repertoire magazine’s “Ten Manufacturer Reps to Watch,” she predicted that consolidation and new performance measures for providers would be two of the biggest changes in medical sales in the coming years. “Consolidation is often the result of new demands for value-based care vs. volume-based care,” she said at the time. “The shift has required healthcare organizations to reshape their internal and external operations, combining www.repertoiremag.com
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Excellence in Sales best practices. In the last year I have seen many new partnerships and acquisitions designed around maximizing patient satisfaction and extending services to new patient populations.” She stands by her prediction today. “I believe consolidation and performance measures are even more impactful in our current climate. Everyone in our industry is being tasked to do more with less. Consolidation can help increase clinical efficiency and meet the needs of our customers today and in the future. Performance measures have become increasingly more valuable in driving valuable decisions and accountability among peers. “We are seeing more consolidation from hospital mergers and acquisitions,” she continues. “As value-based care increases, there is a rise in financial pressure on our providers. Large systems acquiring physician office groups have increased the need for standardization and created new challenges for distributors. Changes in ownership of our accounts often results in changes in responsibility for the decision-makers within both hospital and physician offices.” Not surprisingly, salespeople have to remain educated about all the changes taking place, and adapt accordingly, she says. Distributors are an essential part of the process.
“It is imperative to work together with your distribution partners to be supportive of changes and continue to uncover new opportunities. Together as a partnership, it is our role to introduce solutions to their changing needs.”
A good place to be Medical sales is a good place to be today, and will remain so in the future, says Bishop. She advises recent graduates seeking a career in medical sales to apply for outside sales jobs with upward mobility. “Continue to build your brand and expand your skillset relevant to the medical industry. Keep an ongoing file to save awards and acknowledgements. Take advantage of every opportunity to network and learn from peers. Connect with a good medical sales recruiter who can connect you with any open positions.” On February 8, the Bishops welcomed home a healthy baby girl, Charlotte Ann Bishop. Born at only 32 weeks, she was 3 pounds, 5 ounces, and 16 inches long. After a month’s stay in the NICU, she came home to meet her “brother,” the pug, Arch Bishop.
One take on Claire Bishop Grayson Porter, regional sales director, Mid-Atlantic, for Quidel, responded to few questions about Claire Bishop, this year’s manufacturer recipient of the Repertoire/HIDA Excellence in Sales Award. Repertoire: Talk about Claire Bishop’s relationships with distributors. Grayson Porter: Claire knows her distributors on a personal level, and it shows in the trust that they have in her to take care of their customers. Her formula is simple: She follows through on what she commits to, and she does it when she says she’s going to do it. Repertoire: How about her relationship with end users? Porter: One of the first things you notice about Claire is her attention to detail. Her accounts
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can count on her to come prepared and be knowledgeable not just about the products in her bag, but also about her competition and trends in the market. Over the years, Claire’s accounts have learned to trust her as a valuable source of guidance and information. Repertoire: And her colleagues? Porter: Claire consistently takes on added responsibility and leadership roles on her team. She acts as a mentor to other reps across Quidel and is looked to for guidance and advice on a regular basis.
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SALES
A systematized approach to selling 7 smart ways for healthcare sales reps to build trust and credibility with healthcare providers By Sandler Systems, Inc. For healthcare sales representatives, these are the best of times and the worst of times. It’s the worst of times
because somewhere along the line, your reputation took a hit. As everyone knows, the landscape changed dramatically 10 years ago when you stopped being the “I’ll-bring-the-donuts” or “I’ll-treat-you-to-a-weekend-in-Vail-if-you’ll-favor-myproducts” salesperson. Maybe you’re still dealing with fallout from that change, and looking for ways to offer value instead of dinners and golf trips. That’s hard to do with the industry evolving at warp speed.
It’s the best of times because difficulty is a catalyst for transformation. So transform. Start by bringing your clients real value. Then take your worth to an entirely new level by actively helping them navigate the changes in their world. Here are seven smart ways to do it: No. 1: Think like the person you’re selling to Get inside his or her head, whether you’re dealing with the physician, practice manager, CEO or CFO. Understand 28
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that person’s unique perspective and address it. A physician, for example, will be motivated by patient care and results, while a CFO will respond to information about the financial benefits of your product or service. No. 2: Be different Stand out from the sea of reps calling on your client. Be professional. Set expectations from the start. For example: “I’m going to need more than five minutes of your time if we’re going to have a meaningful conversation.”
Also, rely on the Sandler® principle of getting permission up-front to ask questions. Say, “Is it OK if we start with some questions so I can figure out how to help you?” This approach will make your sales call feel less like a pitch and more like a conversation. No. 3: Be up-front with the incumbent to take the uncertainty out of the transition Remember, the incumbent isn’t necessarily a competitor. It can also be a process. The fact is, organizations usually have to change processes to start doing business with you. That means asking people to change their behavior. It also means asking your contact to do something different and take a risk. People tend to want to avoid taking risks in the workplace, because it makes them fear for their jobs. It’s tempting to sweep potential pain under the rug and hope for the best. Instead, address it early in the sales cycle. Acknowledge that there will be pain, yes, but with great benefit on the other end. No. 4: Do your research. Take a holistic approach to the account The importance of understanding an organization, top to bottom can’t be overemphasized. You probably know reps who zero in on one function. They only call on physicians, for example, hoping these will be the “quarterbacks” to push their product up the line. But they ignore the practice managers – which is a bad idea. Get out of your comfort zone. Do your research. Know when the decision gets made and who makes it. No. 5: Rethink your communication style Always keep one of the oldest Sandler philosophies – the 70/30 rule – in mind. Fight your instinct to do all the talking. Instead, talk 30% of the time, asking questions, and spend the other 70% listening to the answers. Also, be sure to sell your product in a way that’s protective of your client’s ego. Rather than telling a physician to use an endoscope in a certain way, frame it as a suggestion: “Others have used it this way and had a lot of success.” Or turn it into a question: “Have you seen the
research on the new technology that’s finding 20% more polyps?” If a client tells you something you don’t want to hear – that your product is too expensive, for example – don’t defend. Instead, ask why the person feels that way. Get him or her to open up. Your willingness to consider the client’s point of view will build trust. No. 6: Leverage your client relationships and create a referral tree There’s no substitute for great word of mouth. Because the best way to get in front of a prospective client is through an enthusiastic introduction from an existing one, start working on your “referral tree.” Identify a few clients with whom you can talk about referrals, and set dates to meet with them. No. 7: Help your clients from a marketing perspective Hospitals, healthcare systems and healthcare practices are more competitive than ever. They’re looking for ways to differentiate themselves and attract patients, so think strategically to help them with their marketing. Remember that the focus has shifted from “we have great doctors” to “we have state-of-the-art technologies.” Tell them, for example, why your equipment is faster, lighter, more durable or more effective. Do a good job of peeling back the layers, and you might just help a hospital that’s been losing patients to market itself more effectively. How valuable would that make you? Having a systematized approach to selling is crucial for healthcare sales representatives, particularly when the medical world is evolving so quickly. The Sandler Selling System® methodology offers an effective, proven and measurable way to increase sales performance. It doesn’t rely on quick fixes, but instead creates sustainable success through real-world tactics for prospecting, qualifying, making the deal, closing the sale and generating referrals. Send your questions about improving Sales Development in your industry with a proven, systematic approach to selling to SalesTips@repertoiremag.com.
With over 250 local training centers around the globe, Sandler is the worldwide leader for sales, management, and customer service training. We help individuals and teams from Fortune 500 companies to independent producers dramatically improve sales, while reducing operational and leadership friction. ©Sandler Systems, Inc. All rights reserved. S Sandler Training (with design), Sandler, and Sandler Selling System are registered service marks of Sandler Systems, Inc. www.repertoiremag.com
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TRENDS
Athletes, daycare and school students, military personnel in barracks, and those who receive inpatient medical care or have surgery or medical devices inserted in their body are at higher risk of MRSA infection.
MRSA: Still a threat COVID-19 has dominated the news since May, and rightly so. Yet MRSA – short for methicillin-resistant
Staphylococcus aureus – remains a threat in the community, in physicians’ offices, and in hospitals and nursing homes. As with COVID-19, the keys are early detection, treatment, disinfection … and knowledge.
A well-informed sales rep can initiate dialogue and appropriate action among caregivers. With that in mind, Repertoire offers some factual points about MRSA from the Centers for Disease Control and Prevention (CDC).
How common is it? Studies show that about one in three (33%) people carry S. aureus bacteria in their nose, usually without any illness. About two in every 100 people carry MRSA. Although many people carry MRSA bacteria in their nose, most do not develop serious MRSA infections.
What is MRSA? MRSA stands for methicillin-resistant Staphylococcus aureus, a type of bacteria that is resistant to several antibiotics. 30
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Who is at risk? Anyone can get MRSA. The risk increases with activities
How serious is MRSA?
Anyone can get MRSA. The risk increases with activities or places that involve crowding, skin-to-skin contact, and shared equipment or supplies.
Staphylococcus aureus (staph) has become resistant to several antibiotics, making MRSA and other types of resistant staph major antibiotic-resistance problems. In the community (that is, where people live, work, shop, and go to school), MRSA most often causes skin infections. In some cases, it causes pneumonia (lung infection) and other infections. If left untreated, MRSA infections can become severe and cause sepsis – the body’s extreme response to an infection. In healthcare settings, such as a hospital or nursing home, MRSA can lead to bloodstream infections, pneumonia or surgical site infections.
How is MRSA identified in the physician’s office? Recent data suggest that MRSA as a cause of skin infections in the general community remains a high probability. CDC encourages clinicians to consider MRSA in the differential diagnosis of skin and soft tissue infections (SSTIs) compatible with S. aureus infections, especially those that are purulent (fluctuant or palpable fluid-filled cavity, yellow or white center, central point or “head,” draining pus, or that are possible to aspirate with needle or syringe). A patient who complains of “spider bite” should raise suspicion of an S. aureus infection.
How about point-of-care testing?
or places that involve crowding, skin-to-skin contact, and shared equipment or supplies. Some of the people who carry MRSA contract a MRSA infection. Non-intact skin, such as when there are abrasions or incisions, is often the site of such an infection. Athletes, daycare and school students, military personnel in barracks, and those who receive inpatient medical care or have surgery or medical devices inserted in their body are at higher risk of MRSA infection.
How is MRSA spread in the community? MRSA is usually spread in the community by contact with infected people or things that carry the bacteria. This includes contact with a contaminated wound or sharing personal items – such as towels or razors – that have touched infected skin. The opioid epidemic may also be connected to the rise of staph infections in communities. People who inject drugs are 16 times more likely to develop a serious staph infection.
Rapid tests are available. One such test identifies S. aureus and PBP2a, a common marker for MRSA, from blood culture. Another identifies PBP2a in S. aureus culture isolates. In December 2019, the U.S. Food and Drug Administration authorized marketing of a test that uses a bacteriophage technology based on bioluminescence to detect MRSA from nasal swab samples.
Best way to prevent an MRSA infection? ʯ Maintain good hand and body hygiene. Clean hands often, and clean your body regularly, especially after exercise. ʯ Keep cuts, scrapes, and wounds clean and covered until healed. ʯ Avoid sharing personal items, such as towels and razors. ʯ Get care early if you think you might have an infection.
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TRENDS How is MRSA typically treated on an outpatient basis? If the lesion is purulent (e.g., fluid-filled, has a yellow or white center, is draining pus, etc.), the clinician typically: 1. Drains the lesion. 2. Sends wound drainage for culture and susceptibility testing. 3. Advises patient on wound care and hygiene. 4. Discusses follow-up plan with patient, including the possibility of antimicrobial therapy if incision and drainage don’t work. MRSA skin infections can develop into more serious infections. It is important that the physician discuss a follow-up plan with the patient in case they develop systemic symptoms or worsening local symptoms, or if symptoms do not improve within 48 hours.
What safeguards should physician practices put in place to prevent the spread of MRSA among healthcare workers or patients? MRSA can survive on some surfaces, like furniture, towels, razors, and athletic equipment, for hours, days or even weeks. It can spread to people who touch a contaminated surface and can cause infections if MRSA gets into a cut, scrape or open wound. Keeping one’s hands clean is one of the most important steps office staff can take to avoid getting sick and spreading germs like MRSA. Soap and water should be used, if available. After wetting hands and adding soap,
scrub hands for at least 20 seconds. If soap and water cannot be accessed, staff and patients should use an alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands. Apply the sanitizer to one hand, rub hands together, covering all surfaces of hands and fingers until hands are dry.
How can the physician practice clean and disinfect surfaces to prevent MRSA infection? Cleaners or detergents are products that remove soil, dirt, dust, organic matter and germs (like bacteria, viruses, and fungi). They lift dirt and germs off surfaces so they can be rinsed away with water. Cleaning with a detergent is necessary to remove dirt, which can prevent disinfectants from working. Some disinfectants have a cleaning agent mixed in. Disinfectants are chemical products that are used to kill germs in healthcare settings. Disinfectants effective against S. aureus are also effective against MRSA. The disinfectant’s label will have a list of germs that the product can kill, along with an Environmental Protection Agency (EPA) registration number.
What should be cleaned to prevent MRSA from spreading? When cleaning and disinfecting, focus on surfaces that frequently contact people’s bare skin, like desks, chairs, light switches, faucets, remote controls, benches, gym equipment and lockers. In particular, clean any surfaces that could come into contact with uncovered wounds, cuts, or boils. In addition to cleaning surfaces, frequently cleaning hands and keeping wounds covered keeps MRSA from spreading. Large surfaces, such as floors and walls, have not been associated with the spread of staph and MRSA. There is no evidence that spraying or fogging rooms or surfaces with disinfectants prevents MRSA infections more effectively than the targeted approach of cleaning frequently touched surfaces and surfaces that have been exposed to open wounds. Primary source: Centers for Disease Control and Prevention, www.cdc.gov/mrsa.
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TRENDS
Physicians catching on to digital health tools Adoption of digital health tools has grown significantly among physicians since 2016, when the American Medi-
cal Association first benchmarked the integration of health technology into clinical practice. AMA research on digital tools, released earlier this year, shows that the biggest growth in adoption occurred in tele-visits/virtual visits and remote monitoring for improved patient care.
“The rise of the digital-native physician will have a profound impact on healthcare and patient outcomes, and will place digital health technologies under pressure to perform according to higher expectations,” AMA Board Chair Jesse M. Ehrenfeld, M.D., M.P.H., was quoted as saying. The AMA Digital Health Research (www.ama-assn.org/ system/files/2020-02/ama-digital-health-study.pdf) investigates shifts in physician adoption of digital health tools during the last three years, along with current attitudes and expectations among physicians. The research 34
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examines seven categories of digital health tools that engage patients for clinical purposes, interpret and use clinical data, and manage outcomes and other measures of care quality. According to the AMA survey, adoption trends in the following seven categories are helping to propel the digital transformation of healthcare. ʯ Tele-visits/virtual visits. Physician adoption doubled from 14% in 2016 to 28% in 2019, the largest growth among the digital health tool categories. This category includes audio/video connections used to see patients remotely.
ʯ Remote monitoring and management for improved care. Physician adoption jumped from 13% in 2016 to 22% in 2019. This category includes mobile applications and devices for use by chronic disease patients for daily measurement of vital signs, such as weight, blood pressure, blood glucose, etc. Readings are visible to patients and transmitted to the physician’s office. Alerts are generated as appropriate for missing or out of range readings. ʯ Remote monitoring for efficiency. Physician adoption modestly grew from 12% in 2016 to 16% in 2019. This category includes smart versions of common clinical devices such as thermometers, blood pressure cuffs, and scales that automatically enter readings in the patient medical record. ʯ Clinical decision support. Physician adoption climbed from 28% in 2016 to 37% in 2019. This category includes modules used in conjunction with the EHR, or mobile applications integrated with an EHR, that highlight potentially significant changes in patient data, such as weight gain/loss, change in blood chemistry, etc. ʯ Patient engagement. Physician adoption rose from 26% in 2016 to 32% in 2019. This category includes solutions to promote patient wellness and active participation in their care for chronic diseases, such as adherence to treatment regimens. ʯ Point of care/workflow enhancement. Physician adoption modestly increased from 42% in
2016 to 47% in 2019. This category includes communication and sharing of electronic clinical data to consult with specialists, make referrals and/or transitions of care. ʯ Consumer access to clinical data. Physician adoption rose from 53% in 2016 to 58% in 2019, the highest adoption rate among the digital health tool categories. This category includes secure access allowing patients to view clinical information such as routine lab results, receive appointment reminders and treatment prompts, and to ask for prescription refills, appointments and to speak with their physician. Improved efficiency and increased patient safety remain the most important factors driving physician interest in digital health tools, although addressing patient adherence, convenience and physician burnout have increased in importance, according to AMA. Liability coverage remains the most important requirement for physician adoption of digital health tools, and this requirement has significantly increased in importance during the last three years. Electronic medical record (EHR) integration and data privacy rounded out the three most important physician requirements for digital health tools. There was a notable increase in the importance of peer review validation as a physician requirement for digital health tools. Source: AMA Digital Health Research, www.ama-assn.org/ Use of Digital Health Tools in Practice system/files/2020-02/ama-digital-health-study.pdf
Use of digital health tools has risen significantly
Use of digital health tools has risen significantly.
Tele-visits have seen the greatest growth, doubling in use since 2016.
% Currently Using
se of Digital Health Tools in Practice al Health Tools in Practice
47 53
42
37 28 58 14
58 53
12
Tele-visits / virtual visits 2016 2016
16
22
28
47
53
58
33 26
2016 2019
13
Remote Remote monit. & Clinical decision monitoring for mgt for improved support efficiency care
Patient engagement
Point of care/workflow enhancement
Consumer access to clinical data
2019
2019
Q20. Which, if any, of these do you currently incorporate into your practice? Base: Total Physicians (n=1300)
9
© 2020 American Medical Association. All rights reserved.
of Consumer access rkflow to clinical data onsumer access ement
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IDN OPPORTUNITIES
Tony Johnson, senior vice president and chief supply chain officer at Baylor Scott & White Health
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Bold steps How this year’s Contracting Professional of the Year led his organization’s supply chain through a transformation – and realized $92 million in value during the past fiscal year – by moving to a more strategic model By Graham Garrison
Tony Johnson has had the confidence to tackle big projects since early in his career. He credits the U.S. military
Photography by Rusty Schramm
for giving him that confidence. Johnson specialized in healthcare supply chain in the military. While being a supply chain leader in a military hospital was not much different than being a leader or manager in a commercial hospital, the difference was the mission and the scale of the military, he said.
“We always had that underlying mission: Protecting our forces around the globe and being able to support them in any place, any time. The military is designed to basically move an entire warehouse from point A to point B, set it up and have it operational within a couple of days if it has to,” Johnson said. The systems, transportation links, pieces and sheer mass involved with military operations forced you to think bigger, he said, “and, because you’re so used to dealing with so much scale, it takes away the fear of doing something that you haven’t done before.” Military personnel are given the opportunity to do some extraordinary things, Johnson said, “so I think it gives you the confidence to feel that you could take bold steps and you’re going to be okay.” For instance, in 1994 immediately after the Rwandan genocide, Johnson was sent to Entebbe, Uganda, as the senior healthcare logistics officer on a Department of Defense joint task force. He was given a laptop and an Inmarsat satellite communications dish to connect with the medical logistics hub in Europe and the national inventory control point in Pennsylvania. His mission was to set up a system to pull supplies into central Africa and distribute them to refugee camps in Rwanda, Tanzania, Democratic Republic of the Congo, Kenya and Uganda. As the senior healthcare supply chain person in the conflict region, he found himself supporting the U.S. Department of Defense, U.S. Department of State, the Centers for Disease Control and Prevention, the United Nations High Commissioner for Refugees and several non-governmental organizations like Doctors Without Borders. Johnson and a 12-person medical logistics team planned
the shipment of approximately 40 tons of medical supplies, pharmaceuticals and equipment into Uganda and executed the shipment and delivery of those supplies to multiple countries and organizations from Uganda. “We did this with no process manual or instructions,” he said. “You must be ready to leverage your training, think through any objective, develop plans and execute. And of course, we learned very early that transportation, when it comes to pure logistics, is always the Achilles heel. You have to figure out how you’re going to get the stuff there.” Johnson has used that and similar experiences to build a successful career in healthcare supply chain, including in his current role as senior vice president and chief supply chain officer at Baylor Scott & White Health. Johnson is this year’s Contracting Professional of the Year for The Journal of Healthcare Contracting, a sister publication of Repertoire.
From transactional to strategic When Johnson first arrived at Baylor Scott & White in 2016, he took some time to observe how the organization operated before implementing changes. What he noticed was that the integrated delivery network’s supply chain was designed to process orders. Purchasing and payment decisions were made at the hospital level. “That’s what we were staffed for and that’s what we did,” said Johnson. As a result, the organization was paying two to three times more for the same product from one hospital to the next. There was no consistency, Johnson said. “Vendors were charging each one based on negotiations at that individual hospital,” he said. “We saw that across the board. Not only did it cost us, but it increased www.repertoiremag.com
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IDN OPPORTUNITIES the numbers of contracts exponentially when you had to have a contract for every facility with different terms and conditions and different pricing.” To move toward a more strategic model, the supply chain team took a step back to evaluate its marketplace position as well as how it made decisions on supplies. “We should take the $1 billion of spend that we have and make corporate decisions rather than hospital decisions on everything,” Johnson said. Johnson said Baylor Scott & White faced several challenges implementing the new model. The first was cultural. “When you have an organization as large as this, with a lot of prestigious physicians on staff, if it’s not approached in the right way, people may think that you are taking an administrative function and basically telling the clinical side what they should do or how they should practice. That was not the intent at all. It was getting the culture to take a step back and decide what it wanted to do as an enterprise. And then delivering the results,” Johnson said.
recruited seasoned supply chain executives and leaders from different industries. Data, too, posed a problem. “The data was there but being able to do something with it was problematic, so we had to work through that,” Johnson said.
Source-to-settle One concept that helped Baylor Scott & White’s supply chain team implement the new strategic model was a source-to-settle system. Johnson said he looks at sourceto-settle as a work environment or an ecosystem where all processes are integrated and that uses the same set of data for everything related to: ʯ Analyzing ʯ Purchasing ʯ Planning and executing strategic sourcing events ʯ Writing, storing and managing contracts ʯ Ordering products from the contracts ʯ Receiving and invoicing ʯ Instructing the ERP to pay the bills “That puts our operation on steroids in a sense, that we can see what we’re doing real-time,” he said. “It’s more of a point and click or web-based kind of environment. It unleashes the power of research at the fingertips of the users versus having to send a query over to the report writing team for something very detail specific … and hoping that they can figure out a way to get your information back. So this basically pairs down the research and the decision-making capability, and puts everything at your fingertips.” Before source-to-settle, the supply chain team “didn’t even have a clue as to how many contracts we had,” Johnson said. “Today, the first thing I see when I log on, is how many active contracts we have and how many of them are expiring within the next 120 days. That’s on the top of my screen. There’s a shopping cart, graphs and analytics. There’s a panel with my to-do list. Now, there are still things that I need to approve or take a look at. But all of those things were disjointed coming from different systems before. Now it’s all tied together.”
“ We created a very programmatic way of analyzing our spend, identifying opportunity, building the teams to go after that opportunity, developing an enterprise-wide strategy, and then going into the market as a single entity of Baylor Scott & White.” The second challenge was having the right talent. “It takes a very different type of talent to process transactions than it does to mine through millions of transactions, discover what you’re doing, benchmark, understand where the market is, come up with a strategy, get alignment with the stakeholders, build teams that are led by the stakeholders, have targets that are achievable but aggressive targets, and then actually deliver,” he said. To ensure the right talent, Johnson 38
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Improvements While technology played a critical role bringing in $92 million in value to the organization, so did interpersonal dynamics. The team created a commodity management process where MBA-level team members analyzed purchases like orthopedic or cardiac products. “So, we analyzed our spending across the board, we selected what programs that we were going to go after for that year, and we presented that to our senior-level leadership. They bought into it,” Johnson said. The team connected with the service line leaders for each area. The supply chain provided a very detailed, fact-based report with what they had been doing in the past, where they saw benchmarks, and where there was variation. While the supply chain team would present the data to the service lines, it was the service lines that would lead and make the decision, Johnson said. “We would be there as the facilitators to keep the process moving and bringing more data when they needed it. Of course, we were not short of opinions on the process. We gave them a program with opportunity that we could go after as an enterprise. They were very successful in doing that,” he said. People didn’t feel they were in turf fights, Johnson said, “and the very highest levels of the organization, our C-suite executives were involved in some of these discussions. They really pushed us across the board to do the right thing. We created a very programmatic way of analyzing our spend, identifying opportunity, building the teams to go after that opportunity, developing an enterprise-wide strategy, and then going into the market as a single entity of Baylor Scott & White.” Part of that value involves using supply expense as a percentage of net patient revenue as a key indicator. The supply chain team wanted to find something measurable through the financials that would indicate that something good was happening or recognize that nothing was happening. “I think historically, you see a lot of supply chains saying, ‘I saved this or I saved that’ and they put some astronomical numbers up, but when you
look at the financials, it all looks the same or it’s just random noise in the financials,” Johnson said. “We’re actually held accountable to lowering that number. And for us, every half a percentage point we lower that number, it’s $32 million of cost permanently taken out of the system. We’ve lowered at approximately 2 percentage points already.” When looking at the company financials for the last eight years, Johnson said he could see a noticeable change in 2018. “Now, when you look at the financials, the supply line has all sorts of things in it that we’re not accountable for, but even then you see that number start to move south in 2018, when we launched this process,” he said.
Gaining more visibility Johnson said the next phase involves creating dashboards so that every user in Baylor Scott & White, and every administrator, will have access to these dashboards. The dashboards will give them data on their specific piece of the operation and what they need to do. “Healthcare, at least the healthcare systems I’ve been involved with … they will do accruals at the end of the year, but they basically book expenses when bills are paid. So, there’s a lag between that and when you have actually placed an order,” he said. To illustrate, Johnson uses a checkbook metaphor, where you write a check for a product, but when it clears the bank is when it actually shows up as an expense. “Well, we’re going to show the checks that have been written. We’re going to show the things that have cleared the bank and we’re going to show those things that haven’t cleared the bank, that are waiting, so that every user has a look at those all the time and can make the appropriate decisions.” Johnson said he expects to have that capability within six months. “The key to that, again, is the data. The very good data that we can now put together.” Baylor Scott & White is focused on clean, consistent and complete data and on business intelligence tools to unlock the power of data. Johnson expects many more improvements by unlocking information from millions of transactions each year.
“Military personnel are given the opportunity to do some extraordinary things, so I think it gives you the confidence to feel that you could take bold steps and you’re going to be okay.”
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IDN OPPORTUNITIES
Building a team What does it take to build a successful healthcare supply chain team? A combination of thinking inside – and outside – the box.
Front row: left – Janet Watson, Vice President, Strategic Sourcing; Pamela Wiseman, Vice President, Operations Back row: left – Julio Carrillo, Vice President Logistics; Tony Johnson, SVP & Chief Supply Chain Officer; Alan Koreneff, Vice President, Healthcare Technology Management
Tony Johnson, senior vice president and chief supply chain officer at Baylor Scott & White Health, is a big believer in having a well-rounded supply chain team with backgrounds inside and outside of healthcare. “I think it’s absolutely necessary to have people from healthcare, and I also think it’s absolutely a good idea to bring people from outside of healthcare and let them work together and share. That blended expertise, I think, far exceeds the expertise that would come up in healthcare only,” he said.
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Johnson gets excited talking about the supply chain leadership team Baylor Scott & White has assembled: Janet Watson, vice president of strategic sourcing, came from Entergy, an energy company based in New Orleans. “She grew up in the oil industry, and is an absolute superstar,” said Johnson. “I don’t think we could have found anyone better. She has an MBA, she runs all the sourcing events, and she’s the person that’s driving the value capture for us.” Watson had no
healthcare background, but was “just an incredible leader, an incredible manager,” Johnson said. She put on scrubs, visited the operating rooms and cath labs, and made it mandatory for her team to watch the procedures of everything that they were supporting. The physicians became enamored with her team because they showed so much interest, “and they are incredibly bright and smart people,” Johnson said. Pamela Wiseman, vice president of operations, runs the data, systems and technology group. She was the lead on the implementation of Baylor Scott & White’s source-to-settle system. Wiseman came from GE and previously worked with Medtronic. Wiseman has a combined bachelor’s degree in geology, physics and math, a master’s degree in electrical engineering, and she also has an MBA. “Just a brilliant, brilliant person,” Johnson said. “She has brought so much to the table in terms of perspective, and being able to take stats from all of the hospitals across Baylor Scott & White, from South Austin to North Dallas, and create standard practices. I mean, she’s just built an incredible team across the company. And to get the data and the systems and get a value and implement it, she’s done a great job.” Julio Carrillo, vice president of logistics, brought a background of working with automotive supplier companies. He previously worked for Tenneco, GE Transportation, and Kongsberg Automotive, and has run distribution centers. “Julio is our director of logistics, so he is responsible for running our distribution center, transportation, and courier services,” Johnson said. “Julio came on board at a time when we were being challenged, trying to get our center stood up, and he’s done a phenomenal job with that. Again, no healthcare background, and he has just done a great job.” Alan Koreneff is vice president of healthcare technology management. Koreneff worked
with Johnson at Novant Health, retired, and then Johnson brought him on board as a contractor at Baylor Scott & White. Like Johnson, Koreneff has a military background. Koreneff’s group is responsible for repairing the equipment across the enterprise, Johnson said. “These guys maintain 150,000 devices for Baylor Scott & White, and his team has basically insourced the maintenance of 95% of the equipment. They’ve even built a center that repairs surgical scopes significantly reducing maintenance costs, and they plan to cut it more this year, even though the size of the company has grown, and that’s over the last two years.” Infusing thoughts and ideas People from outside healthcare can bring skillsets that are hard to find in people who have focused on the healthcare environment, Johnson said. “They bring a different set of perspectives. They’ve seen supply chains and multiple industries work, and they bring fresh ideas to the table. And their talent level is ... I mean, they’re the best of the best. Supply chain, if you look strictly in healthcare, you’re basically growing from within. You know what you know, or you know what you’ve been taught, and I believe strongly in infusing thoughts and ideas and talents from multiple places and letting them teach each other.” Johnson said today’s supply chain executives need very good quantitative skills. “In fact, they need to be top percentile when it comes to quantitative skills,” he said. “The same with communication skills or the ability to engage and to gain the trust of stakeholders. If they can’t do that, I don’t care how much you may know or think you know about supply chain and process, if you can’t gain the trust of your stakeholders to the point that they are going to trust you to be at the table, to help them make the best decision, then it’s meaningless. You’ve got to be smart and you’ve got to be able to connect with the clinicians.”
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IDN OPPORTUNITIES
More supply chain ripple effects to come At an inflection point, why the supply chain must rise above ‘every man for himself’ type behaviors
The COVID-19 pandemic has brought us to an inflection point. More specific to our industry, we might be at one
of the more important inflection points in the history of the U.S. supply chain, said Jeromie Atkinson, supply chain leader and essentialist, Supply Chain Sherpas. In the last few decades, we’ve seen progressing healthcare supply chain maturity, technology solutions and a more global supply chain all converge.
However, “the supply chain’s inherent inability to sustain longer term disruption with greater resilience should be a call to action for supply chain professionals globally,” Atkinson said. “The supply chain, if we do not react at this time, may end up being exposed as one of the weak links in the health system value chain.” In the following interview, Atkinson provided his thoughts on several supply chain-related topics linked to the COVID-19 pandemic. 42
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Repertoire: Can you provide us with some insights into what is going on at a national level in the U.S. healthcare supply chain? How is the government coordinating with providers, GPOs, associations, etc.? What are the conversations like? Jeromie Atkinson: I haven’t heard of many direct federal government to health system interactions currently taking place at the level of the supply chain, other than monitoring where shortages are occurring or
likely to occur. There tends to be more communication and connection at the state and local level (governor and mayor offices) as officials stay in contact with health system leadership and monitor the situation to be able to react appropriately to the factors that they can control. However, the federal government appears to be working on a more direct basis with health systems on other types of topics, primarily through organizations like the Centers for Disease Control and Prevention (CDC), and that guidance is typically more focused on supply utilization documentation like how to optimize their PPE through restricting use to only those in care areas, reducing face-to-face encounters, cancelling elective procedures, and maximizing telehealth to name a few. The federal government is also working with supply chain’s upstream partners on trying to determine where products may be impacted. For example, the Food and Drug Administration (FDA) has been working with drug manufacturers to remind them of their responsibilities in notifying the FDA on any supply chain disruptions, including analyzing their API and other components manJeromie Atkinson ufactured in China to anticipate shortages. They are also monitoring the situation with the 60-plus medical device manufacturers in China as well as other commodity manufacturers, but it might be too early to tell yet how those will be impacted. I’ve heard frequently from my healthcare colleagues, however, and getting good information is most often what people are seeking. It’s been more difficult than expected to get to one source of truth about current status on topics related to COVID-19. Collaborating, at least at a high level of conversation, does appear to be happening directly in health system to manufacturer or distributor types of interactions, most typically to cover inventory gaps and to look for solutions to cover the immediate needs. There are some discussions taking place obviously from health system peer to health system peer. At Sherpas, we’ve had a number of colleagues over the last couple of weeks reach out, primarily for insights or for general information on what we are hearing nationally. We’ve seen some interest in health system to health system collaboration among some of the providers nationally, but that
doesn’t seem to have gained the traction that it potentially could. The GPOs are offering guidance where they can and are trying to work proactively with their members where possible, and of course the supplier community is trying to be proactive in serving their customers. Repertoire: What about at an individual health system or even hospital level? What does it look like? Atkinson: Many individual hospitals or individual health systems are fending for themselves and doing the best that they can. Typically, the smaller the health system, the more impacted they will be by the unavailability of inventories and the allocation efforts of distributors and wholesalers (for smaller systems, they often have less purchasing power and less influence and may receive less allocation of the available inventory). The impacts seem to be more strongly felt in rural hospitals, those who simply don’t have the space or the purchasing power for large safety stocks of the inventory that is needed today, but we are also in a settling period where inventories and ‘what is real demand’ vs. ‘what is panic demand’ is not well understood. Just like many U.S. citizens made the rush to the grocery store to stock up on unneeded supplies or supplies in excess of what they could consume, there was an initial rush by many to purchase medical supplies, and it is still unknown if that was in excess of need or adequate supply based on need since we are still unable to test or predict the COVID-19 growth at this point and where patient populations may be most intense. Repertoire: What product categories are most effected by COVID-19? Atkinson: This is far more complex than most people realize at this point, because we are too often only focused on the emergency needs of today – PPE, respirators and very likely ventilators. PPE is affected in two ways. Many medical goods like PPE are manufactured in China at factories that were affected by China’s suspension of operations during their height of their case growth, in effect, limiting some of the available supply. Add in the world’s increased need for PPE and you can see the makings of the problems we have in some areas. www.repertoiremag.com
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IDN OPPORTUNITIES There are manufacturers who are shifting to produce more inventory, but that shift does take time to influence current on-hand inventories. The next round of products is those you may not have heard as frequently about in the news. When you look past the immediate supply chain shortages and needs, the future category potential shortages become more complex in other categories and the full scope of that impact will take time to develop. I mentioned pharmaceuticals earlier, but approximately 13% of the API – active pharmaceutical ingredients – in drugs are manufactured in China, so manufacturers in other countries besides China have also gone through lengthy suspension of operations to try and ‘flatten the curve’ in their own countries and workforces. Additionally, the U.S. has a high usage (about 90% of the total prescriptions) of generic drugs. Many of these are Chinese made including antibiotics, diabetes drugs and birth control drugs.
best, some organizations will reach out to others and try and share information at a very high level only, to determine where they might work together to solve problems that they both face. At worst, you will see ‘every man for himself ’ type behaviors with a rush on hoarding products for their own use just like we have seen our neighbors rush out to hoard toilet paper. Both are understandable, if misguided responses. We have to avoid only putting out the fire on our own house while the whole neighborhood is smoldering, because as soon as we get one section put out, it will catch again in another section we weren’t paying attention to. We are at an inflection point in history and maybe one of the more important inflection points in the history of the U.S. supply chain in the last few decades as progressing healthcare supply chain maturity, enabling technology solutions, and a more global supply chain all converge. The supply chain’s inherent inability to sustain longer term It is OK to have missed the signals on disruption with greater resilience should be a call to action for supsupply continuity, and maybe many of us ply chain professionals globally. The have up to this point, but to miss it now supply chain, if we do not react at and going forward would be a potential this time, may end up being exposed as one of the weak links in the health catastrophic failure for our organizations system value chain. yes, but mostly for the responsibility we It is OK to have missed the owe our patients and communities that signals on supply continuity, and we operate in and are a part of. maybe many of us have up to this point, but to miss it now and going forward would be a potential cataThe full impact of how that will affect the drug supstrophic failure for our organizations yes, but mostly for ply chain remains to be seen and may take months to the responsibility we owe our patients and communities develop. The medical device industry is also likely to be that we operate in and are a part of. COVID-19 is our impacted and U.S. reliance on Chinese medical devices current crisis but is extremely unlikely to be the last, and has been a topic with some visibility even prior to the shame on us if we don’t use these experiences to be more coronavirus outbreak. Even when you get outside of the prepared the next time. medical products people typically think of when it comes There is good news though! I’m always humbled by to healthcare, there are likely to be supply chain ripple the talent and commitment in this industry. Once we effects from everything to food products, to linens and get through the immediate crisis, we can use this time textiles, and capital equipment like beds and monitoring to regroup, to think proactively on how we will address equipment and supplies. these challenges in the future to build more collaborative and cohesive relationships with our upstream supRepertoire: How are you advising hospitals and plier partners and their providers of raw materials. As health systems to navigate any supply disruptions? today’s supply chains become more interconnected, Atkinson: Because this is an emergency situation, our and as more manufacturing continues to be located in human nature and the cultural nature of our industry is lower cost countries and regions, they become more to focus inwardly, to huddle up with our own teams and susceptible to global external factors like COVID-19 solve the problems that no one is going to solve for us. At and natural disasters. 44
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When supply chains have visibilWhen you look past the immediate ity as far upstream as possible, they supply chain shortages and needs, the can more proactively react to these future category potential shortages external forces in proactive ways. We can use this time to build sysbecome more complex in other tems to more accurately shift excess categories and the full scope of that inventories to regions of need (heat impact will take time to develop. mapping). We can use our process expertise to support and lend guidance and leadership on the human level, but also work to bring colleagues along supply chain through shifting caregivers to where they for a national discussion. are needed. Ultimately, we should use some time to ʯ Collaborate, collaborate, collaborate. Not reflect on how we can be influencers, champions and just at conferences over drinks, but at formal leaders of the supply chain shift that our own internal levels with industry groups, with your GPOs customers, and more importantly, our patients need us with other members, with informal or formal desperately to be. peer groups, with your supplier partners, with suppliers who are innovative even if you do Repertoire: What are a few things that every supnot have a current contract with them but they ply chain team should being doing today as a are advancing the supply chain agenda nationresult of COVID-19? ally, with local governments, and with clinical Atkinson: Every supply chain team individually should leadership in and outside of your companies. be looking forward to how they can actively help preCollaboration is very much a key enabler of vent supply chain shortages in the future. This doesn’t success in the supply chain and in a time when necessarily mean increasing safety stock levels. ʯ Building upstream visibility and understandwe have more national dialogue around coling where our products come from, the market laboration and more technology enabling colforces they may be susceptible to, and how to laboration, we do not seem to have improved appropriately respond to any one of those indimeasurable collaboration around the topic of vidual supply chains breaking down. supply continuity. ʯ Look for and support emerging technologies that will continue to disrupt, in a positive way, the Jeromie Atkinson leverages more than two decades of industry. Not all of those strategic customer-focused experience and extensive will be successful, but in knowledge of the healthcare supply chain, both as an an Internet of Things internal transformation agent and external business part(IoT) environment, we ner, Atkinson is a passionate educator and advocate for will have to continue to helping organizations develop solutions tailored to their sift through the traffic and own internal DNA and to discover and unlock their own find which introduce meansupply chain abilities. ingful progress and change He earned his supply chain credentials in a variety of and which are noise. When industries prior to joining some of the nation’s most prowe find something worthgressive health systems where he applied his focus and while, celebrate it and passion to elevate supply chain discourse nationally. spread the word. ʯ Build collaborative networks outside of our own ecosysFor more information, visit: www.supplychainsherpas.com. tems. Consider supply chain response teams at the local www.repertoiremag.com
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DISTRIBUTION
Come Together Supply chain leaders met with the president at the White House as part of the COVID-19 Supply Chain Task Force
President Trump held a meeting at the White House on Sunday, March 29, with the leaders of several supply
chain distributors and shipping companies as part of the COVID-19 Supply Chain Task Force.
Med/surg supply chain leaders who participated were: ʯ Brad Connett, president, U.S. Medical Group, Henry Schein ʯ Mike Kaufmann, CEO of Cardinal Health ʯ Charlie Mills, CEO of Medline Industries Inc. ʯ Ed Pesicka, president and CEO of Owens & Minor ʯ Brian Tyler, CEO of McKesson “We’re waging a war against an invisible enemy,” said Trump. “We are grateful for your tremendous partnership – it’s been incredible – and the work you’ve done so far.” Each supply chain representative was given an opportunity to provide an update. The following were comments made by the med/surg leaders at the press conference. 46
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Henry Schein Connett thanked President Trump and his administration for working with Henry Schein on a number of collaborative fronts. “No. 1, we’ve all talked about PPE products – that’s critical, and it’s not just to the hospitals,” Connett said. “It’s a must to the hospitals, but it’s really to all healthcare providers that are working on the front line. Our commitment is to get it to the hot spots, and get it to the care providers who are taking care of those patients. It’s absolutely key.” Second, Connett said the task force talked about the importance of buying American-made products, and getting manufacturing and resources back in America. “It’s a lesson to be learned from where we are.”
Connett also spoke about the importance of more rapid tests to detect COVID-19. As of press time, Henry Schein helped bring two products into the market. The first is an antibody rapid blood test, known as Standard Q COVID-19 IgM/IgG Rapid Test, intended to be administered at the point of care. According to the healthcare company, the test delivers results within 15 minutes from a pinprick with no instrumentation required. Henry Schein will also serve as the exclusive distributor in the United States of a second point-of-care rapid test kit that can detect antibodies associated with COVID-19 in as few as 15 minutes. Working with BD (Becton, Dickinson and Company) and BioMedomics, a North Carolina-based clinical diagnostics company, Henry Schein will make the test kits available to health care professionals as part of the company’s broad offering of point-of-care rapid tests.
McKesson Tyler said collaboration between the government agencies and medical suppliers has been key. “I’d certainly like to echo my colleagues’ comments that the collaboration amongst many of the government agencies and the private market, including the distributors represented here today, has been incredible, and has been increasing and ramping up over the past few weeks.” During his remarks, Tyler referenced an innovative public-private partnership called Project Airbridge, where FEMA and other government agencies will coordinate 50-plus air cargo flights in a span of two to three weeks. Each flight will bring tons of medical supplies to the U.S., directly to the cities where it is most needed. “Today the first delivery of Project Airbridge is evidence that it’s working. The 51 flights the president referenced, we’re excited about. We look to build upon that. So, I would echo my thanks for your leadership, and certainly to the staffs for the terrific partnership and the commitment to protect the people we think about most often, which are the people on the front lines providing care.” Tyler also offered a word of thanks on behalf of all the CEOs present at the task force meeting to the teams of each organization “that continue to show up in warehouses across the country, in pharmacies across the country, and do their jobs to keep the supply chain going. The supply chain is working, it’s resilient, and though supply is a challenge, we’re tackling that.”
Owens & Minor Pesicka said Owens & Minor is leveraging its manufacturing capabilities in America, specifically in North Carolina,
to ramp up production. “We did hear the challenge, and starting in January we’ve ramped up our production in the Americas, including our facility in North Carolina where we are now manufacturing an additional 40 to 50 million masks per month to get into the U.S. healthcare system.” Pesicka said the task force talked about the massive demand increase in PPE supplies. “I used an anecdotal example of one hospital in New York that traditional uses roughly 10,000 to 20,000 masks a week is now using 200,000 to 300,000 masks a week. So you multiply that times the entire U.S., let alone the same demand outside of the U.S., and that’s part of the issue we are running into. Even with a significant ramp up in supply, there is still a demand that is much greater.”
“ The supply chain is working, it’s resilient, and though supply is a challenge, we’re tackling that.” – Brian Tyler, CEO of McKesson
Cardinal Health Kaufmann thanked the president for his leadership. “Because of that leadership, we’ve seen the government agencies working with industry like no time before,” Kaufmann said. “We’ve seen HHS, FEMA, and the CDC work effectively with all of the distributors. And all of the distributors are working together for the good of the people. All of us have been so focused on making sure we take care of our customers because our customers are the ones taking care of the patients every day. We need to do everything we can to make things good for them.”
Medline Industries In his remarks at the press conference, Mills said the demand for supplies has skyrocketed. “We’re doing a lot of things to bring in more masks and other protective apparel,” he said. “We are involved in reprocessing masks. We’ve already started reprocessing about 100,000 masks per day. We hope to expand from there, so we’re quite optimistic about it.” www.repertoiremag.com
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SMART SELLING
Staying strong during the COVID crisis By Elizabeth Hilla In sales, we often say that we put the customer’s needs first. The coronavirus crisis has forced us to really think
about what this means. For weeks, most distributor sales reps have been in maximum problem-solving mode. Their focus has been on getting scarce products to the customers that need them most. They haven’t had time to think about quotas or margins, only on managing high demand and short supply, and trying to ensure that providers have the PPE and other critical supplies.
ʯ We’re more human. We’ve all been on countless
On the other hand, for many of us, putting customer needs first has meant not contacting customers. If our customer is overwhelmed with current needs, and we don’t have an immediate solution, the best course has been to stay out of the way. Other sales reps have been especially challenged, because their products address critical healthcare needs that are not coronavirus-related. For instance, chronic wounds haven’t disappeared during the epidemic, but reaching the right caregivers to discuss wound care solutions has become very difficult. In cases like these, putting customer needs first has meant rethinking how to get products to the patients who require them during unprecedented circumstances. If there is a silver lining to such a devastating situation, I hope it is that we will emerge as better people – and better salespeople. Compared to work life in the beginning of March: 48
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conference calls listening to crying babies, rowdy kids, barking dogs, and more. We know better than ever what it’s like to be worried, confused, and overwhelmed, and we are becoming more emotionally intelligent as a result. ʯ Our empathy level is higher than ever. We understand how insensitive an ill-timed sales pitch can seem. We can use our new insights to better hone our outreach in the future. ʯ We are more tuned-in than ever to our customers’ highest priority: taking care of patients. Some of us have recently been patients ourselves, or worried about loved ones who were sick or hospitalized. We wanted those caregivers to have exactly what they needed to care for patients, and only that. ʯ We understand how valuable a few words of kindness or encouragement can mean when we’re stressed out or overwhelmed, and we’re more attuned to offer such words to others. I emailed a member during the second week of workfrom-home back in March. I apologized that I hadn’t been in touch about an issue. She not only told me not to worry about the slow response, but told me that I was doing a great job, that I was strong, and to keep at it. I saved that email, and have been trying to emulate her by encouraging others to stay strong. Finally, this experience has taught us just how important we are. We are each a critical part of the healthcare supply chain. We are vital to helping clinicians take care of patients. We rise to the challenge and, that member said to me, we are strong.
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HEALTHY REPS
Health news and notes What keeps you up at night?
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It’s true that stress, world events, relationship problems and work can keep you awake at night. But lots of other things can contribute to sleeplessness – many of which you can control, according to BlueCross BlueShield of Illinois. For example, drinking alcohol a few hours before bedtime can lead to poor quality sleep (and force you to get up in the middle of the night to go to the bathroom). Some medications – e.g.., those for blood pressure, depression or asthma – can keep you up if you take the too close to bedtime. Caffeine and late snacks (especially heavy or spicy foods, which can cause heartburn) will do it too. Avoid binge-watching TV, reading or social media when you should be sleeping, and try to go to bed and wake up at the same time each day – even weekends.
University of Bergen in Norway. For the other half of women experiencing heart failure, the cause is generally related to having untreated high blood pressure levels over time, which leads to progressive stiffening of the heart. The researchers compared common risk factors for heart disease and how they affect men and women differently. First, women gain more weight than men, especially as they age, they said. (Obesity increases the risk of having high blood pressure by a factor of three, which, in turn, increases the risk of heart disease.) Second, during the past decade, more women have started smoking than men. And third, as women age, they lose the benefits of the hormone oestrogen, which prevents the formation of connective tissue in the heart. So, in persons under 60, high blood pressure is more common among men, but for persons over 60, it is the opposite.
Women and heart failure
After the flood
More women than men die of heart failure. The reason is that only 50% of the heart failure cases among women are caused by having a heart attack, which can be treated with modern methods, according to researchers at the
Each year, more deaths occur due to flooding than any other hazard related to thunderstorms, reports the Centers for Disease Control and Prevention. The initial damage caused by a flood is not the only risk. After the flood:
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1. Listen to water advisory from local authorities to find out if your water is safe for drinking and bathing. (During a water advisory, use only bottled, boiled, or treated water for drinking, cooking, etc.); 2. Throw away any food and bottled water that comes/ may have come into contact with floodwater; 3. Prevent carbon monoxide (CO) poisoning by keeping generators at least 20 feet from any doors, windows, or vents. If you use a pressure washer, be sure to keep the engine outdoors and 20 feet from windows, doors, or vents as well. Remove and throw out drywall and insulation that was contaminated with floodwater or sewage. Throw out items that cannot be washed and cleaned with a bleach solution – mattresses, pillows, carpeting, carpet padding, and stuffed toys. Clean walls, hard-surfaced floors, and other household surfaces with soap and water and disinfect with a solution of one cup of bleach to five gallons of water.
Strength training Cardiovascular exercise – jogging, bicycling, etc. – is great. But exercises to maintain flexibility, balance, and strength are also important, according to the National Institutes of Health. Stretching gives you more freedom of movement and makes daily activities more comfortable. Balance practice helps prevent falls, which become a concern as you get older. Strength training, also called resistance training or weight training, is particularly important. It makes your muscles stronger, which can help you keep up the activities you enjoy – at any stage of your life. It’s not about getting big muscles, explains Dr. Wendy Kohrt, an aging expert at the University of Colorado. In fact, most people who do strength training don’t see much of a change in muscle size. But at all stages of life, she says, “maintaining muscle mass and muscle function is really important for quality of life.”
store your lenses after each use, and never mix fresh solution with old or used solution. And before you leave, don’t forget to pack backup supplies, including lens case, contacts, glasses and solution.
Hair loss in women About 55% of women experience some hair loss by the age of 70, according to Mayo Clinic. The most common cause is female-pattern baldness, an inherited condition. It’s characterized by gradual thinning of your hair, which may be noticeable as a widening part or a ponytail that’s less hefty than it used to be. Treatment with over-the-counter minoxidil foam (5%) may prevent further hair loss and result in improved hair density. Apply the product at bedtime to wet hair and wash it out when you wake. Then style your hair as usual. You’ll need to commit to a six- to 12-month trial period because it takes three months to begin seeing any effect, and a few more months to determine whether it’s really working for you. If it is helping, you’ll need to continue using the medicine to keep your fuller hair. Insurance usually doesn’t cover the cost of the product.
Stretching gives you more freedom of movement and makes daily activities more comfortable. Balance practice helps prevent falls, which become a concern as you get older. Strength training, also called resistance training or weight training, is particularly important.
On the road Contact lens wearers: If you’re traveling, remember that your eyes need a break. Take out your contact lenses before you sleep, shower or swim, advises the CDC. Failure to do so increases the risk of painful eye infections. Use only fresh contact lens solution – never water – to
Hands off! Among COVID-19’s many lessons, one of the most important is this: Wash your hands to avoid infection. Just as important: Stop touching your face, especially the facial mucous membranes, that is, the eyes, nose and mouth, reports The New York Times health writer Tara ParkerPope. They’re all entry portals for germs. “Scratching the nose, rubbing your eyes, leaning on your chin and your fingers go next to your mouth – there’s multiple ways we do it,” Dr. Nancy C. Elder, a professor of family medicine at Oregon Health and Science University in Portland, was quoted as saying. “Everybody touches their face, and it’s a difficult habit to break.” www.repertoiremag.com
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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 Compact cameras still have a place The best camera, they say, is the one you have with you, write the editors of Wired. That’s usually your smartphone. But there’s only so much it can do. A good compact camera gives you features like optical zoom, better image stabilization, and a bigger sensor for sharper photos, along with nicer dials and controls. These cameras, also called point-and-shoot cams, give you the tools to explore photography in ways that portrait mode simply can’t. In March, Wired gave kudos to Canon PowerShot G7 X Mark II (best overall); Sony Cyber-shot RX100 (best on a budget), Panasonic Lumix ZS100 and Olympus 52
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Tough TG-6 (best for zooming); Ricoh-GR-II (“a cult classic”); and Moment telephoto lens (for phone loyalists).
Killing passwords Time to lose the password. After all, passwords are hard to remember; hackers exploit their weaknesses; and fixes often bring their own problems, notes CNET. Password managers generate strong and unique passwords for every account you have, but the software is complex. Services from Google, Facebook and Apple allow you to use your passwords for their services at other sites, but you have to give them even more power over your life online. And
documents and take on a human in a competitive debate about issues, like whether we should subsidize preschools, reports CNET. In 2019, Big Blue pitted IBM Debater against a champion debater in a live-streamed competition. And now you can use IBM Debater technology to find out if people like you on Twitter. That’s because IBM has begun commercializing aspects of the IBM Debater technology. You can use it in three ways: 1) for sentiment analysis, in which IBM’s software judges how positively or negatively people feel about a subject, based on natural speech and writing; 2) summarizing information (IBM used it to digest information in 18 million blog posts, articles and biographies to generate information about celebrities on the Grammy competition red carpet) or 3) “clustering,” a process of analyzing raw data to figure out when topics are related to each other (a skill that should be useful for insurance, healthcare and manufacturing).
The technology, called FIDO (Fast Identity Online) overhauls the log-in process, combining your phone, face and fingerprint recognition, and new gadgets called hardware security keys. If it delivers on its promise, FIDO will make cringeworthy passwords like “123456” relics of a bygone age. two-factor authentication, which requires a second passcode sent by text message or retrieved from a special app each time you log in, boosts security dramatically but can still be defeated. A big change, however, could eliminate passwords altogether. The technology, called FIDO (Fast Identity Online) overhauls the log-in process, combining your phone, face and fingerprint recognition, and new gadgets called hardware security keys. If it delivers on its promise, FIDO will make cringeworthy passwords like “123456” relics of a bygone age. Still, “from a consumer level, we’re probably five to seven years out from killing passwords being a reality,” said Forrester security analyst Chase Cunningham.
Do you love me? In 2018, IBM debuted technology called IBM Debater, which used artificial intelligence technology to read lots of
An affordable iPhone Apple at press time was reportedly planning to launch a new 5.5-inch entry level iPhone, reports 9to5Mac. (It has been rumored for some time that Apple would soon release a 4.7-inch LCD phone for $400, which reuses the iPhone 8 design with updated internals.) The new phones will also apparently have a solid state home button like the original iPhone 8 and iPhone 8 Plus, rely on Touch ID instead of Face ID, and come with Apple Pay’s Express Transit feature, which lets you just hold your phone near a transit terminal to pay for transit. The new phones will also apparently be able to scan NFC tags without requiring a user to open up an app, a feature that’s currently available only on the iPhone XS, iPhone XR, and iPhone 11. www.repertoiremag.com
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WINDSHIELD TIME Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more.
Automotive-related news
Want to talk emissions? Check your tires! Pollution from tire wear can be a thousand times worse than what comes out of a car’s exhaust, according to Oxford, England-based research firm Emissions Analytics. Harmful particle matter from tires – and also brakes – is a growing environmental problem, one that is being exacerbated by the increasing popularity of large, heavy vehicles such as SUVs, and growing demand for electric vehicles, which are heavier than standard cars because of their batteries. What’s more, vehicle tire wear pollution is completely unregulated, unlike exhaust emission, according to the firm. Non-exhaust emissions (NEE) are particles released into the air from brake wear, tire wear, road surface wear and resuspension of road dust during on-road vehicle usage. Last year, the UK Government’s Air Quality Expert Group recommended that NEE be immediately recognized as a source of ambient concentrations of airborne particulate matter, even for vehicles with zero exhaust emissions of particles, such as electric vehicles.
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by those authorized to drive it. Perhaps more important is that the car owner or car OEM services can remotely terminate or suspend the digital key, when the car is stolen or used for unanticipated purposes, like a getaway car after a bank heist.
Not for your reading pleasure You can personalize a lot of settings in your new car. For example, you can make the mirrors automatically fold when you park, or direct your rear wiper to make a sweep when you shift into reverse. You can activate a “welcome light” display of the car’s logo that is beamed on the ground when you unlock the car, and you can mute annoying functions, like a cruise control that adjusts based on reading speed limit signs. The thing is, you’re probably better off just exploring the settings options on your own rather than reading the owner’s manual, says a recent New York Times article. That’s because owner’s manuals are getting bigger all the time. The book for the new Cadillac ST6, for example, is 384 pages.
In case your vehicle is used as a getaway car …
Solar cars
Carmakers, smartphone designers and chip suppliers have been developing “digital car keys” for some time, reports EE Times. A key factor about the keys is that while they don’t make traditional keys obsolete, they can make other mobile devices, such as smartphones or key fobs, serve as car keys. Even if you’ve lost or left behind your car key, you could still enter and start the car with your smartphone. You could also share the key with others. Now that the key is digital, there is no need for multiple physical car keys for family members or friends. The digital car key can ensure that the car is used only
Adding solar panels to a car roof is not a new concept, with some manufacturers (e.g., Hyundai) already offering them on vehicles. AppleInsider reports that in a patent granted to Apple by the U.S. Patent and Trademark Office titled “Systems with photovoltaic cells,” a thin-film photovoltaic cell could plausibly be placed all over a vehicle, and as depicted in one image, even covering a window, suggesting it may be transparent or sufficiently translucent enough for that purpose. Apple might not stop there, potentially applying the film to the Apple Watch, iPhone and other device cases.
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PEOPLE
Tim Dungey: ‘Exceptional leader, and an even better person’ Tim Dungey, vice president of health systems for McKesson Medical-Surgical, passed away on Feb. 22. The cause
of death was cancer. He was 61. Dungey joined McKesson in September 1987, and held executive positions in its extended care, pharmaceutical and acute care businesses. He served as vice president, West, for Owens & Minor after O&M acquired McKesson’s acute care business in October 2006. In October 2008, he rejoined McKesson, and was named vice president of health systems in September 2012.
“I have known Tim for close to 30 years,” said Gary A high school and college athlete, Dungey coached all Keeler, president of sales and marketing for McKesson three of his children’s teams in basketball from elemenMedical-Surgical. “We first met when he was at Red Line, tary school through junior high school. He was an active which is now McKesson’s Extended Care business. We leader in both youth and high school football programs spent most of our time together talking about strategy for the Lakeridge community in Lake Oswego, Oreand large accounts. gon, where he lived most of his adult life. “I will always remember Tim as a creative and competitive friend who loved his kids and loved watching “ His leadership was deeply influenced them grow in sports and personally.” by his experience as an athlete and “We lost an exceptional leader, the power of teamwork. To that end, and an even better person,” said for over 30 years he inspired the E.V. Clarke, managing partner, EV3 Solutions, and a long-time distripeople he led and worked with to bution executive. “Tim had a promake a collective commitment to found influence on so many of us each other, thus allowing them to who worked with him at Red Line, McKesson and Owens & Minor. accomplish collectively more than “His leadership was deeply they could individually.” influenced by his experience as – E.V. Clarke, managing partner, EV3 Solutions an athlete and the power of teamwork. To that end, for over 30 years he inspired the people he led and worked with to make a collective commitment to In lieu of flowers, send donations to the Tim each other, thus allowing them to accomplish collecDungey Scholarship Fund. Checks payable to Laktively more than they could individually. eridge High School (please reference Tim Dungey “For many of us, we lost a friend who took a sincere Donation) may be sent to 1235 Overlook Drive Lake interest in our lives. Our prayers and thoughts are with Oswego, OR 97034, or credit cards are accepted by his family.” calling (503) 534-2319. www.repertoiremag.com
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NEWS
Industry News Cardinal Health names Jason Hollar as new chief financial officer Cardinal Health (Dublin, OH) announced that its board of directors elected Jason Hollar as CFO, effective May 12. Hollar most recently was the CFO of Tenneco Inc., a global automotive products and services company, and previously was CFO of Sears Holding Corporation. As Cardinal Health Jason Hollar CFO, Hollar will lead financial activities across the enterprise, including financial strategy, capital deployment, treasury, tax, investor relations, accounting and reporting. He will succeed Dave Evans, who has been serving as interim CFO.
Sri Trang USA hires Darren Zwick as director of distributor relations Sri Trang USA announced it has hired Darren Zwick as its director of distributor relations. Zwick will be responsible for creating opportunity with national and regional distributor accounts for Sri Trang USA to extend the value of its infection prevention products to customers across all healthcare segments. Zwick has spent more than 20 years in the dental industry and has over 10 years of experience in both the distribution and manufacturing industry identifying market opportunities and establishing effective relationships. Throughout his career, Zwick has developed innovative sales and marketing strategies to accelerate revenue growth with endusers. On the manufacturing side, he has worked with distribution by training sales teams, providing end-user solutions, creating marketing resources and developing partner programs that resulted in increased sales opportunities. Zwick received a Bachelor of Arts from Olivet College in Business Administration with concentrations in management and marketing. 56
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Masimo to acquire TNI medical AG Masimo (Irvine, CA) entered into a definitive agreement to acquire TNI medical AG (Würzburg, Germany), an innovative ventilation company. This follows Masimo’s August 2019 disclosure of an investment in TNI that included an exclusive option to acquire the company. TNI’s novel softFlow technology is designed to provide high flow, warmed and humidified respiratory gases to spontaneously breathing patients suffering from serious pulmonary conditions. The softFlow technology provides efficient, quiet and comfortable respiratory support by generating a precisely regulated, stable high flow of room air or a mix of room air and oxygen. The system, comprised of an integrated flow generator, respiratory circuit, and patient interface, operates without the need of pneumatic systems (i.e. compressed air supplied from the hospital wall) and can be used both in the hospital and at home.
Midmark RTLS names new vice president Midmark Corp. announced Susan Martin will join Midmark as vice president, Midmark RTLS in Traverse City, Mich. In this leadership position, Martin will be responsible for accelerating the Midmark RTLS business transformation and growth by developing bestin-class customer experiences Susan Martin through strategic focus, innovative product solutions and operational excellence. Martin previously was VP, commercial business at Medicines360, where she defined and executed the commercial business strategies that led to significant organizational growth each year. Prior to this, Martin held senior-level and management board positions with the healthcare companies Johnson & Johnson, Zimmer Biomet and Invuity.
Patient positioning can make all the difference for consistent BP measurements. We know you realize the importance of blood pressure capture, the effects it can have on diagnosis and the impact to patients. However, following AHA/AMA recommendations for patient positioning during BP capture will help ensure more consistent, accurate and repeatable BP measurements. Something as simple as the patient’s feet not resting flat on the floor can increase the measurement by 5 to 15 points.1
May is National High Blood Pressure Education Month and we want to help bring awareness to this important topic. Download the Point of Care Ecosystem BP Checklist and share with your customers. Visit: midmark.com/BetterBPREPmay
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https://www.ncbi.nlm.nih.gov/pubmed/10450120
Š 2020 Midmark Corporation, Miamisburg, Ohio USA
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