His cholesterol is alarmingly high.
He could know this in 5 minutes.
Her A1C hasn’t been checked in a year.
She could have it checked in as little as 3 minutes.
Highly accurate HbA1c test results in as little as 3 minutes.
Highly accurate cholesterol test results in just 5 minutes.
POC testing has been shown to:
• Increase patient satisfaction
• Improve operational efficiency for HCPs with fewer follow-up calls and letters
• Increase patient compliance and management of diabetes
LESS THAN 7% OF US PATIENTS ARE TESTED AT THE GUIDELINE-RECOMMENDED FREQUENCY
THE AFINION™ 2 ANALYZER is the first and only POC CLIA-Waived HbA1c machine providing highly accurate HbA1c test results in as little as 3 minutes. Afinion™ 2 helps your customers better manage their patients with diabetes.
Patient Profile: Leah Age 43 Has diabetes Doesn’t know her A1C levels
See page 55 to learn more about the Afinion™ 2 Analyzer.
Scan the QR code to learn more.
Patient Profile: Andrew Age 57
Has a family history of cardiovascular disease (CVD) Has high cholesterol
THE CHOLESTECH LDX™ SYSTEM is the #1 choice of healthcare professionals, offering highly accurate POC cholesterol test results in just 5 minutes. The CLIA-waived Cholestech LDX™ System can help your customers identify those patients with CVD
See page 39 to learn more about the Cholestech LDX™ System.
These cases are presented for illustrative purposes only. No real patient name or case is used.
Contact your Abbott cardiometabolic account executive today to learn more about cholesterol and diabetes management at the point of care. You can also visit us at Abbott.com/poct.
the
code
learn
In Search of Certainty
Buyers weigh ‘Made in America’ against greater global diversification
Buyers weigh ‘Made in America’ against greater global diversification
for you,
and
always here
help
the highest quality results.
your customers, every result matters.
This is going to be a different kind of Publisher’s Letter, because I just finished “Top Gun Maverick” on a Delta flight to visit clients. I have to talk about the movie, how it connects to this issue of Repertoire, and give you some exciting news that should be a game changer in your day-to-day life calling on providers.
First off, the movie – I mean OMG why did I wait so long to watch it? Talk about feeling 100% American and proud of it. I saw “Top Gun” in the 9th grade on a date with a 10th grader. I remember walking out of the theater thinking I wanted to be a naval aviator. Well as those of you who read this column each month know, making it through aviation school wasn’t in the cards. However, the movie rekindled the feeling I had back then, and how proud I was to be an American.
The timing of me watching the movie could not have been better consid ering this is our annual Made in America issue. We talk to manufacturers who produce here in the U.S. and hear from providers on how important that is to our healthcare system. Hopefully you will take the story to your clients and help support these American companies.
Now, on to the Repertoire news I mentioned. In 2012, we created an app called RepConnect. Many of you used it and found it incredibly valuable. Over the years, though, it became dated and tired. In November we will unveil the new and improved version of the app.
I am not going to tell you today what’s new, but instead I want to tell you why we made this investment. The simple answer is you, our reader, and for the manufacturers that believe in you. RepConnect’s “WHY” is to give you a place to connect with the industry, your peers, and the manufacturers who help you make a living.
We will continue to tell you more about the app in the coming months. I am so excited for you to see it and allow it to help you save time, add benefit to your customers, and keep you connected daily.
Happy selling from one proud American to over 6,500 other proud American professional medical salespeople.
Dedicated to the industry, R. Scott Adams
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Making sense of the home lab testing market as it stands today, and how the industry can point it in a positive direction for the future.
Home lab testing has been around for many years, since the first glucose monitors were intro duced for home monitoring in the early 1970s. They were intended to serve the needs for diagnosed diabetics to help improve glucose levels through frequent monitoring. Many easy-to-use general health screening tests followed, including routine urinalysis for general health. Fecal occult blood tests for colorectal cancer then came along. Later on, a variety of tests for abused drugs joined the portfolio. Pre-COVID there were many over-the-counter home tests for general health and wellness, diabetic monitoring and even screening for abused drugs.
By Jim Poggi
Providing ease of use and an easy to acquire sample, they had one thing in common: they were intended to be used to provide information spe cific to a single patient as opposed to diagnosing a communicable condi tion that could be transmitted to oth ers. As a result, while not reporting a result of these tests always reduces data useful to the healthcare system in general and to the patient’s care giver specifically, ramifications of the absence or presence of the data in the patient’s record only influenced the path to care of a specific individual.
Fast forward to the last 18 months and COVID has, once again, changed
the landscape dramatically. COVID has created a far broader level of access to home testing and increased public awareness to the value of home tests. At the same time, sev eral different companies have begun offering home sample collection tests for sexually transmitted infec tions (STIs). There is even at least one test for HIV that can be per formed and read at home.
No one can argue that these trends are not valuable to the general public, the healthcare community and those of us who manufacture or distribute these important tests. But, nothing is free and they do come
with some costs that balance patient responsibility, privacy and access to data valuable for treatment and epi demiological purposes. In this col umn, I will explore the advantages of the emerging technology, discuss some of the challenges their deploy ment creates, and even suggest some ways to take a large leap forward and attempt to fill some of the gaps in data availability that currently exist.
Three general categories emerged as I researched the market. The first is well known as the “worried well,” which includes folks who test know ing they already have a chronic con dition that needs monitoring, and those who willingly take control over their own health and perform some vital signs and routine urinalysis tests at home. Joining these ranks are two new groups which I will take the liberty of naming: The “expected to be detected,” group, subject to home drug tests either voluntarily, perhaps as a preview to pre-employ ment screening or involuntarily due to the influence of family or friends. They are distinctly different from the worried well. Then there is the “sus pected infected” group, which today includes a group who have options for home testing for respiratory or sexually transmitted infection tests.
It is likely that infectious dis ease tests will continue to migrate to the home environment and will shift some of the burden of decid ing whether to initiate a treatment program from the physician office to the home user. In and of itself, this is not a bad thing, as it empow ers patients to take ownership of their health and personal habits that influence health outcomes.
But home testing, as it exists today, largely leaves some unan swered questions about result qual ity, privacy, access to the informa tion and whether and how it makes its way into the patient record and public health data base. Let’s look at some positive developments, and some areas I believe are subject to improvement.
The technology is there The technology in use today for most home tests has been subject to FDA oversight and CLIA waiver. The process has been rigorous. COVID tests have been launched under Emergency Use Authoriza tion, and while less rigorous than the 510(k) process, these tests have been subjected to internal and FDA review. Overall, I do not believe there is a general quality issue, and test performance in every category is better than in previous years, and continues to improve. It is reason able to conclude that the products will continue to get easier to use, and that a wider range of new tests will be forthcoming. As an associated issue, standardization is a require ment for tests, especially for chronic conditions, to be comparable across platforms and home testers. All signs point to broader patient access to testing and results appropriate to high quality patient care.
However, quality is also influenced directly by the knowledge and skill of the person performing the tests. The first-time home user faces a learning curve, and help needs to be readily available even for the sim plest test procedures. This is one area where manufacturers of homeuse tests can and should be able to provide online resources to both
the patient, virtual visit practitioners and the clinicians most likely to pro vide first-line patient care for these clinical conditions. Current technol ogy and resources should be able to easily bridge any issues here. Manu facturers and distributors need to put a training and support strategy in place to assure user confidence and proper results.
What about accessibility, HIPPA compliance and privacy?
This is where things get murky. Home tests decidedly improve accessibility of tests, but inherently do not pro vide a formal mechanism to commu nicate the data beyond the user. As an example, in the respiratory testing market, over 1 billion COVID anti gen tests have already been provided to home users by the federal govern ment, with the Biden administra tion pledging an additional 1 billion tests. Assuming the U.S. population at about 330 million, that’s about six tests per person – very impressive access to testing.
automatically report the data. There have been innovative software solu tions that were inspired by the initial interest from companies and the fed eral government to provide a “vac cinate or test” solution for a healthy workplace. The ones I am familiar with provide an impressive range of options including automating test recognition, video monitoring of the testing process to assure the test is cor rectly performed, and documented and providing test results to only those designated by the person performing the test at home. In effective use, these tools have the technology to fill some gaps in availability of test data, even while the patient has control over who can see the information.
Solutions of this sort need to be well understood and considered for implementation more broadly across home testing products and platforms. Today, they are more a novelty associated with COVID test ing than a broadly used solution to data access, HIPPA compliance and patient privacy.
So, what about result reporting?
The Institute for Health Metrics and Evaluation has estimated that only about 7% of all COVID test results have made it into the public data base. Whether this fact changes the over all treatment picture for COVID or not, it shows a very substantial miss in data completeness. In the early going, most lateral flow COVID antigen tests were sent to patients for use without any accompanying way to
One additional option to assur ing test quality and accessibility is easily available via virtual patient visits, during which the test can be proctored in real time, the patient coached through any questions or issues they have in properly per forming the test, and results made available as part of the record of the virtual visit. Understanding the level of resources required to provide this solution on a large scale is a key
Home tests decidedly improve accessibility of tests, but inherently do not provide a formal mechanism to communicate the data beyond the user.
consideration. Virtual visits have scaled up substantially since the inception of COVID, so at first blush, this approach seems plausible.
A different challenge to result accessibility involves the increas ing number of patient portals used, particularly by older adults with mul tiple co-morbidities and who may be likely to be less technically proficient. As an example, an elder patient may have their records stored by their pri mary care practice, local hospital, state department of health as well as associ ated specialists. It is possible for their information to be housed in four or more separate EMR systems. Typi cally, the best EMR provider solutions permit the aggregation of the dispa rate information under general head ings (history, test results, etc.) so the full picture is accessible to both the patient and their primary care givers in the primary care giver’s EMR. Of course, this accessibility is compro mised by any information that does not find its way into the patient record.
Does diagnosis lead to treatment? One argument advanced to mitigate the impact of unreported tests is to assume that patients with discom fort and overt symptoms are likely to present themselves for treatment. For symptomatic patients perform ing at-home tests, the answer is likely to be determined by the particular condition, their assessment of the potential duration and seriousness of the illness, concerns about trans mission to others and availability of a cost-effective treatment.
For respiratory conditions, it seems clear to me that there will be a range of patient responses largely based on the severity and duration of their symptoms, their co-mor bidities, access to a trusted clini cian and whether they believe there is an affordable and effective treat ment. I am surmising that socio economic factors including general access to healthcare and disposable income will come into play in this decision process.
Drug tests fall more into the cat egory of whether an individual with a positive test result sees a reason to change their behavior and make lifestyle changes. Pre-employment screening and parental or peer pres sure are likely factors to influence WHO tests, but I do not perceive a clear-cut answer on who reports the test results based on the history of personal lifestyle choices.
STIs also seem to fall into a grey zone. Syphilis, gonorrhea, chlamydia, and HIV are all reportable diseases, and, as such, a positive result needs to be reported to public health authori ties. Today, there are two general types of home tests for STIs: those where the patient receives a sample collection kit and instructions and sends them back to a reference labo ratory to be performed, and a more limited range of tests that can be per formed and provide a result at home. For the lab tests, the responsibility to report a positive result for a report able STI resides with the lab. From my research, they typically advertise confidentiality as defined by not informing the patient’s partner(s), insurance carrier or primary care giver. But they are required to report positive test results in conformance with general CDC requirements for STIs as well as regulations that vary from state to state.
In the case of a home test, the responsibility resides with the patient. One home HIV test I know of requires any patient experienc ing a positive on the home test to have a second confirmatory test performed by a qualified labora tory. This improves the compliance picture, but is certainly no guaran tee of compliance. Treatment deci sions are far more likely to moti vate result reporting and follow up, especially in the case of HIV. But
Xpert
social considerations will also play a role. Patients may be concerned about negative impact on an inti mate relationship, shame by fam ily and peers, as well as potentially exposing some level of informa tion about their sexual practices. These is no simple answer here. How big of an issue could this be?
In 2018, there were 26 million STIs reported in the U.S. per the CDC. They report that 1 in 5 Americans have an STI, though most STIs are not reportable. Approximately 92% of all STIs are not reportable and include HPV, herpes, and tricho monas infections. So, this is a signif icant healthcare consideration, and while it seems obvious that positive results for reportable tests need to be reported, there are any number of reasons why they may not be.
assure that all the educational and training materials needed to make the home user confident and com petent are in place. At the same time, manufacturers and distribu tors should reinforce this message about their mutual commitment to result quality and patient educa tion to the clinical community. It is important that our commitment to result quality be known and under stood to assure this market remains viable and positively impacts the overall healthcare system.
I am going out on a limb here and propose that to the extent possible, the diagnostics community, both manufacturers and distributors, find reasonable ways to assure that results
How about PAMA? Nope, it is in the best interests of manufacturers and distributors to get ahead of the curve and discuss and develop rea sonable solutions. There are ways to do so, some simpler and less expen sive than others. This leads us to options 3 and 4.
Option No. 3: Develop a working group of manufacturers and dis tributors with a common interest in a workable solution and create an “open architecture” solution to data collection, management and reporting across testing systems. Some solutions have already been developed for COVID antigen test ing, so it is technically feasible.
Option No. 4: A leading manufac turer or distributor COULD go on their own and develop a unique, proprietary solution they would implement as part of their sustain able customer value proposition. My experience is that without strong patents and intellectual property pro tection, these proprietary solutions have a relatively short market life. But there is certainly some appeal to being a first mover in implementing a solution of this type.
What are the remaining gaps to man age the delicate balance between access to home tests, privacy, data accuracy and results being incorpo rated into the patient record? Let’s take a look.
This one is well under control from the technical performance perspec tive. Current test systems provide simple, easy to use and accurate test results. Their performance and variety of available tests continues to improve. We need to strive to
are placed in the patient record in accordance with HIPPA regulations and CDC reporting requirements. In my view, this area is where the gaps are greatest. There are four options I can think of:
Option No. 1: Ignore the situation and hope it goes away. Avoidance never really works and is irrespon sible to some extent. Non-runner in my opinion.
Option No. 2: Wait for the govern ment to come up with a solution and work with it. Remember CLIA?
Not going away Home testing is here to stay and has several positive benefits regarding providing needed tests to patients and assuring a new and improved level of test access. For this prom ise to be kept and for the market to remain viable in the long run, new, innovative ways to manage the test ing process and result reporting gaps need to be considered, explored and implemented. Interesting times ahead for all of us. The decisions we make will be a factor in shaping the future of this market.
Home testing is here to stay and has several positive benefits regarding providing needed tests to patients and assuring a new and improved level of test access.
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patients undergoing knee or hip arthroplasty. J Comp E Res 2018;7(10):975-987.
Experimental E icacy Study of Coated VICRYL Plus Antibacterial Suture in Guinea Pigs Challenged with Staphylococcus aureus. Surg Infect (Larchmt) . 2004;5(3):281-288. 5. Ming X, Rothenburger S, Nichols MM, Rothenburger S. In vivo antibacterial e icacy of MONOCRYL Plus Antibacterial (Poliglecaprone 25 with Triclosan) suture. Surg Infect (Larchmt) . 2007;8(2):1-5. 6. Johnston S, Chen B, Tommaselli G, Jain S, Pracyk J. Barbed and conventional sutures in spinal surgery patients: an economic and clinical outcomes comparison. J Wound Care . 2020;29(5):S9-S20. 7. De Cock E, van Nooten F, Mueller K, et al. Changing the surgical wound closure management pathway: time and supplies with PRINEO* vs. standard of care for abdominoplasty surgery in Germany. Poster presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 11th
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First and foremost, teams need to be agile in the complex world of health care. At Advantus, we have set up an organizational design that relies on pro cess, consistency and quality. Our clinical teams within supply chain are tightly ingrained with our sourcing personnel. Our operations teams are centrally led with a strategic mindset but have dedicated professionals at each facility to oversee and answer the day-to-day questions. Everyone works together and leans on each other to tackle the complexities of the supply chain.
There are key indicators I look for when assessing team members. The first being an innovative thinker. Much of what we do requires creative think ing. Daily, we’re making square pegs fit into round holes. I’m looking for a team that can look at complex challenges and be able to develop new solu tions, or at least be willing to test new ideas.
Additionally, I’m always look ing for folks who are data-driven. It might seem obvious, but the data needs to be interpreted so we can make actionable decisions. It’s one thing to look at a data set and take it at face value; it’s quite another thing to look at a data set, be curious, and dig deeper. If the pandemic has taught us anything about the supply chain, the data is complex, and we need teams to be thoughtful and curious about the trends they’re seeing and evaluating.
Lastly, I want the team to be service-driven and grounded in who the customer is. Supply chain excel lence is rooted in customer satisfac tion. We must know our customers and make sure their needs are met. If we can consistently meet and exceed customer expectations, we will grow our business while helping those who depend on us manage theirs.
I love a challenge and the purchase service arena is the next frontier.
Currently, the space can be best described as “chaotic.” I mean that it’s not optimized or organized, and benchmarking is minimal in the United States. As experts, we need to look at that world differently. We cannot continue to do the same things we’ve been doing. It will take fresh thinking and likely some trial and minimal error before we see a system that works. I’m excited and energized to work with my team to finally tackle this challenge.
There are three key areas that I believe the pandemic has changed supply chain in a positive way. The first change is the renewed focus on strategic supplier and distribution relationships. Strong and mutually beneficial relationships are critical when the unexpected pops up. We remained successful throughout the pandemic because we had the ability to rely on suppliers because of our relationship building efforts.
Another critical and lasting move is improving our ability to forecast issues in the global supply chain. While we cannot predict everything, the pandemic has taught us to pay closer attention to small shifts glob ally to better prepare for larger more impactful events. The supply chain is reactive, and we are more alert to global trends than ever before.
Lastly, we’ll continue avoiding analysis paralysis and being nimble. Often, when we see the small trends mentioned above, we need to make quick, but educated, decisions early on. Advantus was successful from the start of the pandemic because of this skill, and because of that, Bon Secours Mercy Health clinicians and patients never experienced a lapse in PPE.
Advantus launched in January 2021 and was created to challenge what is believed to be a dated industry norm of your “Group Purchasing Organi zation is your supply chain solution.” I firmly believe there should be a tan gible link between your supply chain’s physical and digital attributes. Under standing the data is crucial but taking a step off the page sets the stage for actual conversion to value. Our model
goes beyond the traditional design, creating a proactive approach focused on people, processes and technology – knowing advancement comes from an alignment of all three. Our solu tions aim to overcome today’s obsta cles and provide enhanced healthcare services for other systems, communi ties, caregivers and patients.
Throughout 2021, we continued to grow, and I hired and welcomed three new executive leaders from highly regarded health systems across the U.S. – each bringing diverse expe rience with them. In 2021, Advantus secured $25 million in savings for Bon Secours Mercy Health through more than 35 initiatives.
at Baptist Health. My passion for developing young talent was carried into my tenure at Bon Secours Mercy Health (BSMH). Since 2016, 13 administrative residents have gone through the BSMH supply chain program. One hundred percent have been offered and taken a role within the health system following their didactic requirement.
My mentoring philosophy is based on inclusivity. From day one, residents are invited to executive lead ership meetings, given critical project work, and provided ample opportu nity to present and inquire. Across the board, supply chain associates know a resident’s role and are open to help.
In November 2021, Advantus ranked 7th in Gartner’s Healthcare Supply Chain Top 25. As a top new comer, I am so proud of our team.
Also, this past April, Advantus was recognized as a leader in the field of supply chain automation when named to the 2021 GHX Millennium Club. This recognition demonstrates dedication to leveraging the supply chain to provide quality patient care by generating over 1 million auto mated transactions annually through the GHX Exchange.
Before I began my career at Mercy Health, I had already been involved in mentoring administrative residents
I’m proud to say, my very first res ident still works for me since coming with me from Baptist Health and has taken three different roles at BSMH and is currently the VP of Insights, Integration and PMO for Advantus.
Failure to accept failure and learn from it. If you’re doing everything perfectly the first time, you’re not taking any risks and you’re not improving. Failure is a part of curiosity and curiosity is needed to grow. I need my team to look at the data and test new ways of accom plishing goals. If I don’t allow them the flexibility to try things that might fail, we’ll never grow and discover new and more streamlined approaches to a successful supply chain.
Our model goes beyond the traditional design, creating a proactive approach focused on people, processes and technology – knowing advancement comes from an alignment of all three.
How one NASCAR driver has turned a childhood diagnosis into a passionate pursuit while competing at the highest level of racing.
Will Rodgers has been racing most of his life, ever since his mom encouraged him to get behind the wheel of a go-kart at 8 years old. “Most moms don’t really think about getting their son or daughter into a high-speed vehicle,” he said. “But my mom said, ‘You know what? Let’s go for
zone with a tent. When someone walks up, a staff member will ask if they’ve heard about the campaign, and if they’d be willing to be tested. If yes, they will fill out a few forms and take the test with the help of a CLIA-waived technician. “Within about 20 minutes, we can provide an indication for a hepatitis C reac tion with the OraQuick device,” Rodgers said.
Now 27, Rodgers competes on the NASCAR circuit, despite man aging an underlying liver condition. As a young child, Rodgers was diag nosed with primary sclerosing chol angitis (PSC), a chronic liver disease caused by progressive inflammation and scarring of the bile ducts of the liver. While he’s been living healthy for over 20 years, going through that experience, and knowing he could be a positive influence for liver health, led him to start The Will Rodgers Liver Foundation.
Currently in the United States, one in 10 people are affected by liver disease, and over 2.4 million Ameri cans are living with hepatitis C (HCV). According to the American Liver Foundation, about 40% of adults
in the U.S. living with hepatitis C may not know it. The Foundation provides an interactive environment at race events and select community locations to encourage liver health. Through Rodgers’ collaboration with OraSure Technologies, individuals are provided with free HCV testing from CLIA-waived healthcare profes sionals using the rapid point-of-care OraQuick HCV Rapid Antibody Test, which allows them to receive results in as little as 20 minutes with a simple finger prick, educational materials and resources to take the next step for those with liver health needs.
Testing on a NASCAR weekend usually runs Friday through Sunday, Rodgers said, with Race to End HepC staffers set up in the NASCAR fan
People can either wait for their result at the event, or have it deliv ered the following week. “Most folks are on vacation, and don’t really want to know right then,” Rodgers said. “That’s where we offer the option to reach out the following week with that potentially hard information to hear. But we are always prepared to support individuals in the right way.”
Part of that support involves educating people who test positive that there is treatment, and a cure, for Hep C. “I want everybody to have a fun experience, whether it’s at a NASCAR race or another sport ing event,” Rodgers said. “But when given the opportunity, you should take advantage of being tested and staying on top of [your health] because you never really know with a disease like hepatitis C. Someone could live with it unknowingly for years without showing any symptoms.”
To listen to the full podcast, visit https://bit.ly/3euSdKF. For more information, visit racetoendhepc.com .
Detec tion is the first step to prevention, and one of the best ways to diagnose and help stop the spread of HIV and HC V is with OraQuick®.
The OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test is an HIV test that offers several specimen t ypes, including oral fluid, fingerstick whole blood, venipunc ture whole blood (all of which are CLIA waived) and plasma.
The OraQuick® HCV Rapid Antibody Test is the only CLIA waived point of care hepatitis C test on the mark et today, detec ting HC V antibodies in fingerstick and venipunc ture whole blood
When utilized together, both tests form the OraQuick rapid point of care platform that allows clinicians to batch tests and optimize each patient visit.
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North Carolina-based Atrium Health recently dispatched the first of four mobile medicine units designed to provide high-quality, equitable healthcare in underprivileged com munities. The unit was made pos sible by a $1.2 million gift from The Tepper Foundation. The monetary gift from The Tepper Foundation will advance Atrium Health’s efforts to address the underlying needs of patients by extending social service resources to individuals through community health workers, referral navigators, and the Atrium Health Community Resource Hub.
“This innovative care model supports Atrium Health’s efforts to offer patients convenient access to care where they live, work, and play,”
said David Tepper, owner of the Carolina Panthers and Charlotte FC. “Our organizations share the same passion for empowering people in high-risk communities to improve and achieve their best health.”
The vehicle, dispatched from the Mobile Medicine headquar ters on Beam Road, headed to Anson County for its first day of patient visits. The vehicle will serve South Mecklenburg, Anson and Union Counties around the greater Charlotte region.
The mobile units will each have a three-person staff comprised of a Family Nurse Practitioner, Driver/ Registrar, and a Certified Medical Assistant. Collectively, the units are expected to serve over 480 patients by the end of the year. The unit funded will provide primary care/screenings
in the South Market. Other commu nity funders are supporting two addi tional primary care mobile units for the West and North Market, as well as a women’s care unit – for a total of four mobile units to hit the road by year’s end.
WEST: Children’s genomics study at Intermountain reaches enrollment milestone Intermountain Healthcare’s ground breaking HerediGene: Children’s Study – the world’s largest DNA mapping effort ever to be undertaken in kids – has reached a milestone of 2,500 enrollments. The increase in children participating in this pio neering study gives researchers more information to understand the causes of genetic diseases and discover treatments to help children thrive.
“The involvement of so many children and families in this study is really powering progress,” said Josh Bonkowsky, MD, PhD, professor of pediatrics at University of Utah Health and director of Primary Chil dren’s Center for Personalized Medi cine. “It shows how our community is partnering to transform discovery and opportunities for treatments for pediatric diseases.”
Launched in late 2020 by Inter mountain Healthcare scientists, the HerediGene: Children’s Study, aims to collect 50,000 DNA samples of children, newborn to 18 years old, to help them access future treatments and possible cures for genetic dis orders, based on their unique DNA. The 2,500 patients enrolled in the study includes both pediatric patients and parents who participated with their children. The adult samples will ultimately contribute to the 500,000 adults sought to participate in the HerediGene: Population Study.
Family participation in the study adds genetic information to help researchers at the Intermoun tain Primary Children’s Center for Personalized Medicine, in collabo ration with pediatric physicians and scientists from University of Utah Health, and Intermountain Preci sion Genomics better understand genetic diseases in children.
PMB along with The University of Chicago Medicine broke ground on a new two-story, 130,000-squarefoot multispecialty care center and micro-hospital in Northwest Indi ana for what will be the academic health system’s largest off-site facility and its first freestanding building in
Indiana. The $121 million state-ofthe-art care center, at I-65 and 109th Avenue in Crown Point, is expected to open in spring of 2024.
During the on-site ground breaking ceremony on August 3, 2022, hospital leaders and Crown Point’s mayor spoke about the ben efits of the new care facility to the community and broader Northwest Indiana region.
An imaging center with MRI, CT, PET, X-ray and ultrasound capabilities
An outpatient surgery center
Laboratory services
Medical offices with access to UChicago Medicine’s physicians and specialists, including those in cancer care, cardiology, digestive diseases, orthopedics,
Since October 2021 when the initiative was first announced, plans for the new facility have evolved and grown. Hospital leadership worked with partners in the project and Crown Point officials to make sure the new facility can meet future healthcare demands of the North west Indiana community.
The Crown Point care center will include:
A micro-hospital with an eightbed emergency department and a short-stay inpatient unit
A comprehensive cancer center with infusion therapy as well as radiation, medical and
neurosciences, pediatrics, primary care, surgical specialties, trans plant care and women’s health
In addition to developer PMB, other partners in the project include Walsh Construction and architecture and design firm Perkins & Will.
The Crown Point center is expected to have 110,00 patient visits each year and create at least 150 highpaying clinical and nonclinical jobs.
The multispecialty care facil ity adds to the presence UChicago Medicine already has through smaller medical offices in Northwest Indiana – in Munster, Merrillville, Westville and Schererville.
There is nothing more routine than getting your vital signs checked in a physician’s office. Whether it’s blood pressure, respiration rate, oxygen sat uration, pulse or temperature, every patient who steps into a primary care office expects to get their vital signs checked. While it’s a routine process, we may not necessarily consider how important that procedural step is to our overall health and well-being.
In a recent podcast, host and Repertoire Publisher Scott Adams sat down with Kylie Gilberg, the marketing manager for the Midmark digital diagnostic product category, to discuss the importance of accu rate vital signs checks and ECG test ing in primary care.
Gilberg said, “There are a lot of different areas of clinical care that we can take into consideration, but when focusing on the primary care clinic and office space, 60% of the time is spent in this environment1 compared to all other sites of care. With the majority of the office space visits being made for the primary care physician, it’s likely that they are the healthcare provider patients are seeing the most frequently.”
There are two key areas to con sider when evaluating the benefits of
the primary care setting, according to Gilberg. Checking vital signs at every health visit helps physicians make important decisions about preventa tive treatment for emerging health issues, as well as managing those health issues before they become so serious that they require hospitaliza tion or emergency services.
According to Gilberg, there are three major areas where sales reps can lend their insight and expertise to assist customers through some of the common challenges in acquiring and documenting vital signs in the primary care setting:
1 Workflow: There are plenty of different ways to set up a workflow within a primary care office, but many of these could be impacting productivity and effi ciency. By utilizing an all-in-one automated vital signs device with an integrated and standardized workflow at the point of care, it can ultimately save the customers time and money, while also improving patient outcomes. Caregivers can reduce the margin
for error with an automated device, helping to ensure that patient vital signs are measured the exact same way every time.
2 EMR connectivity: Human variability within the primary care setting is unavoidable, and it can result in mistakes. Gilberg said, “Studies have shown that manual transcription of vital signs data can produce a 17% error rate2. Using blood pressure as an example, it can significantly impact the diagnosis and care of a patient.” Additionally, using EMR connectivity will help ensure that the collected data is documented accurately.
3 Staff training: Finally, ensur ing that the primary care staff are up to date on all training will empower them to better under stand how to use the equipment and take care of their patients. By providing primary care staff with the proper training and education on the products, manufacturers can elevate the customer relationship. Discussing staff training, Gilberg said, “New technologies and workflow are only effective if we use them correctly.”
Buyers weigh ‘Made in America’ against greater global diversification
COVID-19 and attendant supply chain difficulties have shaken up healthcare providers, manufacturers and dis tributors. Trust in overseas sourcing, domestic trucking and railroad carriers, and low-unit-of-measure systems has eroded. Certainty that Product A would arrive at Point B in a timely manner and in good shape was replaced with uncertainty.
Providers, suppliers and manufacturers are wonder ing if they can regain some certainty by increasingly turn ing to U.S.-based suppliers or whether they should hedge their bets by diversifying even further among global ones.
“During times of disruption, healthcare organizations must prioritize certainty of supply,” says Cristina Indiveri, associate vice president, strategic programs and contract services, Vizient. “They want the confidence to know they have access to essential medical supplies, back-up manu facturing sources and diversified product availability. Orga nizations are requesting complementary relationships with secondary domestic suppliers to ensure product and prod uct category stability. The objective is balance.”
The consumer press has reported that fervor among healthcare providers and suppliers for the “Made in the USA” brand has diminished along with the threat of COVID-19. For example, an April 2022 article from the Associated Press reported that many U.S. companies that began producing personal protective equipment “with patriotic optimism have scaled back, shut down or given up.” Another article, in Newsweek, reported that most of the 30 small U.S. mask manufacturers in the American Mask Manufacturers’ Association were in jeopardy as demand declined.
“While the demand for domestically manufactured products has fluctuated during the past 12 months, Vizient members are still prioritizing American-made per sonal protective equipment, facial protection and other critical items,” says Indiveri. “Members are asking for sup ply assurance via increased supplier and product options. They want diversification and incremental product avail ability, a balance between just-in-time delivery and stock pile inventory, including domestic products, to create an increased number of products in the supply chain.
According to Vizient Senior President Bryan Gross man, “Members know that the global supply chain fluctuates in ways we cannot control. So while they’re focused on supply assurance, they still prioritize domes tic manufacturing as part of a diversified sourcing strat egy. ... Those medical device suppliers who have been able to stand up additional facilities and source raw materials from a broader supply chain have been more successful in maintaining inventory levels and reducing supply disruptions.”
Many players in the healthcare supply chain – including the Biden administration – believe “Made in the USA” must remain a true north if the country is to survive the next pandemic or geopolitical conflict.
In a July 2021 document, “National Strategy for a Resilient Public Health Supply Chain,” the government declared that a resilient supply chain – which would include domestically manufactured medical products and equipment – “is essential to maintaining the national health security of the United States.” The document was a collaborative effort of the departments of Health and Human Services, Defense, Homeland Security, Com merce, State, and Veterans Affairs.
Scale and cart manufacturer DETECTO has been a believer in U.S. sourcing and production for years. “From our founder’s ethos and our general company perspective, DETECTO has always tried to produce as many of our products in-house under one roof,” says Vice President Jonathan Sabo. “We try to outsource our products, parts and components outside the U.S. as little as possible. We are a vertically integrated manufacturer by nature, so this allows us to control our own destiny. I won’t say that our focus has shifted since the pandemic as much as we’ve been rewarded by it ... by being able to produce stock for orders where other manufacturers bringing products in from overseas couldn’t.”
A wholesale, impactful shift toward domestic sourcing and production won’t happen overnight. “Thus far, we’ve seen a more industrial approach to domestic manufac turing via direct grants and/or Defense Production Act investments,” says Soumi Saha, senior vice president of government affairs for Premier. “While these actions rep resent important and meaningful progress, scaling domes tic and diverse manufacturing isn’t going to come easy. It will require a continued and massive effort on behalf of the U.S. manufacturing industry and the federal govern ment to generate the additional necessary public policy support (i.e., tax incentives and other affordable financing options) for U.S. manufacturers to truly compete in the cost-competitive global marketplace.
“Committed purchasing volume is also important to provide domestic manufacturers the assurances they need to increase supply, invest in redundancies and enter or re-enter the market,” she says. “To that end, and as an example in the private sector, hundreds of Premier mem ber health systems have co-invested alongside Premier
‘Committed purchasing volume is important to provide domestic manufacturers the assurances they need to increase supply, invest in redundancies and enter or re-enter the market.’
and/or have made long-term purchasing commitments with U.S. manufacturers, including Prestige Ameritech for N95 respirators and face masks, DeRoyal Industries for isolation gowns, Honeywell for nitrile exam gloves and Exela Pharma Sciences for pharmaceuticals, including some critical shortage drugs. Through these initiatives, participating Premier members can diversify their supply sources at a price point competitive with overseas manu facturing. The suppliers have also increased their produc tion to protect providers from ongoing shortages.
“Lastly, while we appreciate [the Centers for Medi care & Medicaid Services] looking at differential reim bursement for domestically made N95 masks for 2023, Premier would like to see that expanded to all domesti cally manufactured critical medical supplies and drugs.”
The call for “Made in America” medical products and equipment preceded COVID-19, but the pandemic raised its voice.
“COVID was a wakeup call that rang the alarm bell on issues with the globalization, overseas overreliance and fra gility of our supply chains,” says Kyle MacKinnon, senior director of operational excellence for Premier. “Now and for the future, healthcare providers want more products made here in America – and they are taking a holistic view of the whole value chain, from design production to deliv ery, and how to make it more reliable and dependable.
“Together with our members, we believe our strat egy, including diversification and domestic manufacturing
investments, intentional design, automation and lower shipping costs can help mitigate disruptions and is an innovative model for long-term resiliency. This requires thinking beyond ‘moments-in-time’ and to long-term solutions, as the last few years have clearly shown us that disease outbreaks, natural disasters and other disruptions or emergencies can and do happen unexpectedly and seemingly at a moment’s notice.”
Says Jonathan Sabo, “We are seeing overseas shipping costs and raw material costs coming back down, but only a little bit. We’ll probably never return to the pricing we had pre-COVID. U.S. components suppliers we use that might have been shut down at times due to COVID infec tion rates are also now fully back up with little chance of closing again due to infection rates escalating. Container shipping from overseas during 2020-2021 was brutal, but we are seeing the congestion easing this year in 2022 and returning closer to normal speeds. All these overseas issues cause everyone to drive the focus back to American medical products and keeping supply chains as close in proximity as possible.”
“Healthcare organizations need the ability to predict product availability and adjust early in the supply chain process to ensure supply delivery,” says Indiveri. “They are requesting improved visibility into raw materials and other manufacturing factors. Hospitals are asking for noti fication when a variable will affect their primary supply so they can purchase from other suppliers or implement con servation strategies. Healthcare organizations continue to request domestically manufactured products not only to meet their short-term needs, but also to ensure a resilient and sustainable supply chain in the years to come.”
Indiveri believes that buying American-made products will continue to bolster supply assurance based on a vari ety of factors, including:
Reinforcement of the nation’s supply chain operations to better withstand disruptions, generating greater independence and stability amid global turmoil.
The ability to decrease product shipping times and expedited lead times.
Spurring of the U.S. economy.
Creation of American jobs.
Increased innovation, as manufacturing and invention are intrinsically linked.
Operation
Taiwan dominates the market, but new law could help U.S. producers
Among the many deficiencies in the U.S. healthcare supply chain exposed by the pandemic was the precariousness of obtaining the semiconductors and advanced chips needed in today’s medi cal technologies. In July 2022, a Deloitte survey of medical device manufacturers found semicon ductor disruptions were continu ing and that medical companies were facing depleted inventories, reduced manufacturing and extended lead times. Globalization was a factor.
Taiwan makes 65% of the world’s semiconductors and almost 90% of advanced chips, according to Voice of America. By comparison, the U.S. produces approximately 10% of the world’s supply of semiconductors and none of the most advanced chips.
“Healthcare has many sup plies where semiconductors are used – MRI machines, pacemakers, blood pressure monitors, chemis try and blood gas analyzers, and bedside and wireless patient mon itors,” says Soumi Saha, senior vice president of government affairs for Premier. “Over the last few months, we have not seen direct shortages of semiconductors in healthcare resulting in impacts to patient care, yet a proactive approach is warranted to mitigate potential disruptions.”
DETECTO Vice President Jona than Sabo says, “While we popu late our own printed circuit boards in-house at DETECTO’s factory in Webb City, Missouri, we aren’t immune to chip shortages, and our management team has had to work with overseas vendors in some cases to keep our inventory up throughout the past 2 ½ years.
In some cases, we had to switch chips in products since the older chip had grown astronomically expensive, which wasn’t in line with our competitive market pric ing. In some isolated cases, a few products were on backorder for several months, but by this point those backorders have released and we’re offering stock again.”
of semiconductors, but also other at-risk healthcare products,” says Saha. Premier also believes that semiconductors should be prioritized for healthcare sup plies. “Unlike the consumer tech and automotive industries, healthcare has smaller volumes of chips comparatively (less than 1% of the overall market), yet
The CHIPS and Science Act, signed into law in August, is intended to encourage domestic develop ment and production of semi conductors and advanced chips. The law provides $52.7 billion for American semiconductor research, development, manufacturing, and workforce development. It also provides a 25% investment tax credit for capital expenses for the manufacturing of semiconductors and related equipment.
“[Premier believes] the CHIPS and Science Act of 2022 represents a critical step forward to boost domestic production, diversify the supply chain and increase competition with China and other overseas manufactur ers – strategies critical to not only help prevent shortages
the need exceeds that of other industries given the potential for patient harm.”
Says Bryan Grossman, senior vice president, strategic supplier performance & category manage ment for Vizient, “The prioritization of the healthcare sector with chip manufacturers is critically impor tant. Medical device corporations are at a severe disadvantage competing against large electronic companies and automaker vol umes. ... Unfortunately, there is no simple solution. The investments into the U.S. semiconductor manu facturing afforded by the CHIPS Act will not provide immediate relief. It will take time to increase produc tion and expand or open new manufacturing facilities with the impact anticipated over the next 5 to 10 years.”
‘CHIPS and Science Act of 2022 represents a critical step forward to boost domestic production, diversify the supply chain and increase competition with China and other overseas manufacturers.’
For person-centered care, home-like settings are needed, but financing is elusive
To call something “imperative” means it is urgently needed. But merely calling something “imperative” won’t necessarily make it happen. For example, the urgent need to reform how nursing home care is financed, delivered and regulated may be imperative, but financing substantial improvements in the nursing home environment – including bricksand-mortar changes, such as private rooms and easy outdoor access for residents – is the tough part.
Part of high-quality nursing home care has to do with the physical environ ment of the nursing home itself. And by and large, it’s not in good shape.
The nursing home infrastructure is aging, and most facilities resem ble institutions more than homes, according to the NASEM Com mittee. Smaller, home-like envi ronments can promote infection control and enhance quality of life for residents and staff. With that in mind, the authors made the following recommendations:
This spring, the National Acad emies of Sciences, Engineering and Medicine (NASEM) released a 350page report titled, “The National Imperative to Improve Nursing Home Quality: Honoring Our Com mitment to Residents, Families, and Staff.” It follows by 36 years the 1986 Institute of Medicine report on “Improving the Quality of Care in Nursing Homes,” as well as the Omnibus Budget Reconciliation Act of 1987 (OBRA 87), which established more stringent stan dards for nursing homes in a wide range of areas.
Some quality improvements have occurred since 1987, the NASEM authors point out, but the COVID-19 pandemic “lifted the veil,” revealing and amplify ing long-existing shortcomings in nursing home care, such as inad equate staffing levels, poor infec tion control, failures in oversight and regulation, and deficiencies that result in patient harm. The pandemic highlighted nursing home residents’ vulnerability and the pervasive ageism evident in under valuing the lives of older adults, they said.
Create incentives for new con struction and renovation of nurs ing homes to provide smaller, more home-like environments and smaller units within larger nursing homes.
Ensure that new designs include private bedrooms and bathrooms.
Allow flexibility to address a range of resident care and rehabilitation needs.
It’s not the first time that poli cymakers and others have called for changes to the physical environment of nursing homes.
In October 2020, the “Keep ing Seniors Safe from COVID-19
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Through Home Design Act” called for the U.S. Secretary of Housing and Urban Development, Secretary of Agriculture, and Secretary of Health and Human Services to conduct a study to identify improved home and housing design features and improved design features in nursing homes and assisted living facilities. (The act was never signed into law.) The intention was to help prevent and protect against the spread of infec tion by communicable diseases and suggest how design features could be afforded. The study would have con sidered any advantages from updated or improved heating, ventilation or air conditioning systems; installation of hands-free sinks; incorporation of outdoor space; and redesign and reuse of existing space.
In March 2021, the American Health Care Association (representing about 14,000 skilled nursing centers and service providers) and Leadin gAge (the association of nonprofit providers of aging services) released their “Care For Our Seniors Act,” which called for modernizing nurs ing homes for resident dignity and safety, and shifting to private rooms whenever possible.
The average nursing home is around 40 to 50 years old, accord ing to AHCA and LeadingAge. “The current reimbursement system incentivizes providers to put multiple long-stay residents and/or short-stay patients in the same room in order to make ends meet. Residents deserve better, and nursing homes must con tinue to evolve.
“These traditional care models for long-stay residents are no lon ger considered appropriate, as a new, welcomed emphasis on person-cen tered care continues to emerge. One
central aspect of this shift is a greater emphasis on residents’ autonomy, dignity, and privacy. Increased pri vacy can also enhance the quality of care delivered, especially considering COVID-19 best practices and the efforts to promote infection preven tion and control.”
The Nursing Home Improvement and Accountability Act of 2021 (which was referred to the Senate Committee on Finance, where it now rests) would have allotted $1.3 billion to establish a demonstration program for select
skilled nursing facilities and nursing facilities to modify the built environ ment to pursue resident-centered care approaches. The facilities (or portions of existing facilities) would maintain no less than five and no more than 14 residents and would include:
Private rooms and bathrooms when possible.
Shared space, including a central living area with a communal din ing table and accessible kitchen.
Accessible outdoor space, includ ing a protected garden space, for use by residents and their visitors.
The physical environment described in the proposed law mimics to some degree The Green House® Project (GHP), which encourages the development of Green House homes – primarily licensed skilled nursing facilities –which are small, self-contained, and which include private rooms and bathrooms for all residents, a liv ing room with fireplace, and easily accessible outdoor spaces.
Given that nearly 1.3 million Ameri cans reside in 15,000 certified nurs ing homes in the United States, how many could be housed in these smaller, more personal facilities? Good question.
“Transformative nursing home culture change is only likely to occur if policymakers and voters make this a priority,” David C. Grabowski, PhD, professor of health care pol icy, Department of Health Care Policy, Harvard Medical School, and a member of the NASEM Commit tee on the Quality of Care in Nurs ing Homes, told Repertoire . “To date, that has, unfortunately, not been
the case. Thus, nursing homes with more home-like settings and singleoccupancy rooms are the exception rather than the rule. Research sug gests that these types of nursing homes are more likely to be nonprofit-owned and consist mainly of private-paying residents.
“However, this can be changed by public policy,” he says. “Current research finds that states that reward nursing homes through Medicaid for these types of culture change prac tices are more likely to have innova tions in care delivery such as singleoccupancy rooms and more activities for residents. Change will only hap pen through policy reform.”
It won’t happen overnight, but policymakers can encourage inter mediate steps in addition to full transformation, he says. “For exam ple, state Medicaid programs can pay a higher rate for single-occupancy rooms, and states can more strongly enforce activities and resident engagement as a condition of Medi care/Medicaid participation. A range of payment and regulatory levers are available ... to transform nursing home care.”
A spokesperson for LeadingAge told Repertoire, “It is important to note that there are other ways to cre ate environments that are small and homelike, short of tearing down all nursing homes and replacing them with small houses.” Some Leadin gAge members create “neighbor hoods” within larger nursing homes, each with their own dining and com mon spaces. “Nursing homes are peoples’ homes. Recognizing that and restructuring to accommodate this can be an important first step.”
In its report, the NASEM Commit tee admits that funding has been and will remain a key issue for some time. “For many decades, the nurs ing home sector has experienced underinvestment in ensuring the quality of care and a lack of account ability for resource allocation,” they wrote. “The report’s recommenda tions likely will require a significant investment of additional financial resources at the federal and state levels and from nursing homes. However, the committee noted that key partners, such as CMS, may not currently have the full authority or resources to carry out the actions recommended, and therefore, con gressional action may be required.”
“The math is simple,” said Lead Age President and CEO Katie Smith Sloan when the NASEM report was published. “Medicaid, the dominant payer of long-term care services, doesn’t fully cover nursing homes’ costs, especially the cost of provid ing quality care. As policymakers consider how to enact the report’s recommendations, they must back their actions with sufficient funding to make changes a reality.
“Without that, the committee’s work will be for naught.”
How healthcare providers benefit from medical PPE gloves made in the United States.
Doctors, nurses, and other healthcare professionals rely on nitrile gloves for most aspects of their daily work, in addition to COVID-specific testing and vaccinations. But not all nitrile gloves are approved for medical use, and even approved nitrile gloves sourced overseas can leave your healthcare organization vulnerable to the crippling PPE supply chain breakdowns that materialized through much of the pandemic.
means that SHOWA has brought to market the first-to-market biode gradable medical nitrile glove using Eco Best TechnologyTM. By using SHOWA’s Eco Best Technology TM (EBT), M7005PF is fully biode gradable, breaking down by 82% in just 386 days when tested using standardized protocols.
When GPOs or hospitals are searching for PPE suppliers, domes tic manufacturers can offer medical gloves certified as safe and effective for healthcare professionals. By sourcing every aspect of medical glove produc tion – from nitrile rubber to product packaging – from the U.S., SHOWA is investing in buying American and improving product availability.
During recent acute supply shortages, sorting legitimate PPE purveyors from fraudulent operators was often a challenge for consumers and busi nesses. But in the medical industry, hospitals, group purchasing organiza tions (GPOs) and other buyers faced an even greater challenge in trying to source approved PPE, sometimes leaving frontline workers vulnerable.
When manufacturers onshore their supply chains, the result is a more resilient supply of nitrile medi cal gloves. That’s why domestically sourced medical PPE gloves – mean ing gloves made in the United States
and manufactured end-to-end with American materials and equipment – are critical to protecting frontline healthcare workers and Americans.
SHOWA recently received FDA 510(k) approval across its M7005PF single-use nitrile glove product line. M7005PF is a Class I Medical device (glove) intended for medical purposes in medical exams or any environment where the examiner and patient require protection from contamination.
The benefits extend beyond hand protection; the FDA 510(k) approval
Like much of the single-use equipment used in a healthcare set ting, medical disposable gloves make up part of the larger concern around PPE waste. Until recently, no medically-approved gloves were avail able in biodegradable formulations, but the FDA’s approval of nitrile gloves with Eco Best Technology means SHOWA can now provide the medical industry with biodegradable gloves that can dramatically cut down on PPE waste in the long term.
Domestic PPE manufacturing requires substantial upfront invest ment, careful planning, and business relationships built over decades of trust to source quality materials and highly technical equipment entirely within the U.S.
Tapping into the full potential of primary care providers will mean the U.S. healthcare system investing more in new payment models and the workforce in general.
Time and time again, primary care has shown it’s importance to the health and well-being of patients. In fact, it’s the only part of healthcare where an increased supply leads to better population health and more equitable outcomes, said Dr. Christopher Crow, the CEO with Catalyst Health Group. “That’s because primary care providers have an opportunity to help patients earlier, explore their health in a deeper way and support them over the full course of their lives,” he said.
Dr. Crow is a founding part ner of Primary Care for America, (PCfA) a collaboration focused on demonstrating the value of primary care, the need for increased primary care investment and the impor tance of innovation in primary care delivery and payment models. PCfA is comprised of a diverse group of key partners in the American health care industry: agilon health, Aledade, American Academy of Family Physicians, American Col lege of Physicians, Catalyst Health Network, ChenMed, Elation Health, Everside Health, MDVIP, One Med ical and VillageMD.
In the following interview, Dr. Crow provided his thoughts on how the U.S. healthcare system can better prioritize primary care, the importance of supporting new mod els of care, the current state of the primary care workforce, and more.
Repertoire: How do we better prioritize the role that primary care physicians play in patient health and wellness?
Dr. Christopher Crow: We have to start by recognizing once again that primary care is about more than just access and convenience. Primary care should be far, far more than aDr. Christopher Crow
transactional experience. In fact, pri mary care has shown time and time again to be the only part of healthcare where an increased supply leads to bet ter population health and more equi table outcomes. That’s because primary care providers (PCP) have an oppor tunity to help patients earlier, explore their health in a deeper way and support them over the full course of their lives.
But to empower PCPs to do that, we have to support new models of care, starting with changing payment structures. By shifting from the stan dard fee-for-service model to valuebased care with a prospective payment model, PCPs can focus more on
we expect from PCPs in our current system. If we want that to change, we need to change the incentive structure and move away from a sys tem that disproportionately rewards volume over value.
Specifically, we need to move to value-based constructs that include prospective payment as a core element. Doing so will encourage PCPs to pri oritize relationship-driven care for their patients. When PCPs don’t have to correlate the number of appoint ments in their days with their financial stability and success, they’re freed from the hamster wheel. Instead, they can form longitudinal relationships with
156 PCPs per 100,000 lives. In Texas, the coverage is less than half of that, 74 PCPs per 100,000 lives.
Unless we can make primary care more economically viable and give PCPs the support they need, we’ll see the number of PCPs continue to decline and in frightening ways. We improve that by creating better answers for struggling providers: pay ment models that align better care with better economics; technologies and teams to help PCPs know that they don’t need to do everything on their own; more visibility to the viability of primary care as an attractive field that gives providers the daily opportunity to connect with patients and make an enduring impact on their health.
delivering personalized care to each patient … rather than constantly hav ing to worry about the volume of patients they can see each day. And then we can support this model fur ther by arming PCPs with technologies that connect the care experience and teams of care coordinators, pharma cists, social workers and more – all of whom can deliver specialized expertise in the moments that matter most.
Repertoire: How do payment models factor in? How do we reduce fee-for-service and promote other models, and what are some examples of those other models?
Dr. Crow: Payment models are the key. It’s completely naïve to expect anyone to work for extended periods of time against their own financial best interests. But that’s exactly what
patients and lean on their extended teams to support patients at each step. We see this evolution from transactional experience to more of a holistic, subscription experience in so many other parts of our lives –from movies, to music, to fitness and more. In every instance, it’s created an improved consumer experience. It’s time for that in healthcare as well.
Repertoire: What does the current primary care workforce look like?
What is its current trajectory?
And how do we improve it?
Dr. Crow: To be blunt, the current state of the primary care workforce in the U.S. is declining, with turnover causing nearly $1 billion in excess spending. Here in Texas, we’re seeing a shortage that far exceeds the rest of the nation. In the U.S. there are
Once again, the prospective pay ment model would allow teams and technologies to scale PCPs and help them meet the supply and demand issue we face, all while leading to better outcomes. These outcomes include provider satisfaction, which would also improve the supply demand challenges over time.
Repertoire: What are some examples of innovation in primary care that is changing local communities for the better?
Dr. Crow: When the COVID-19 pan demic hit, we saw the rise in telehealth services as a viable option for health care and an equitable route to provid ing primary care. Telehealth allowed physicians to provide care to people who faced barriers to care. However, care can’t exist solely through virtual interactions because not every con dition can or should be addressed through virtual appointments. PCPs need to adopt an omnichannel model that combines the accessibility of tele health with in-person care to build meaningful relationships with patients in ways that fit patients’ lives.
It’s completely naïve to expect anyone to work for extended periods of time against their own financial best interests. But that’s exactly what we expect from PCPs in our current system.
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State providers and health plans to increase access to advanced primary care.
As part of a new multi-stakeholder initiative, six health care organizations serving California have signed a memorandum of understanding (MOU) to increase investment in and access to ‘advanced primary care,’ a model that emphasizes comprehensive, person-focused care, integration of behavioral and physical health services and high-quality outcomes. The agreement outlines a new initiative that strengthens the primary care delivery system throughout the state by enabling primary care practices to transform to a high-performing, value-based care model that reduces costs and improves quality and equity.
Known as the California Advanced Primary Care Initiative, the effort is jointly led by California Qual ity Collaborative (CQC), a program of the nonprofit coalition Purchaser Business Group on Health (PBGH), and the Integrated Healthcare Asso ciation (IHA). CQC and IHA con vened the state’s largest payers to collectively adopt a model to trans form primary care statewide.
six organizations committed to the California Advanced Primary Care Initiative include:
Aetna
Aledade
Blue Shield of California
Health Net
Oscar
UnitedHealthcare
The initiative is a first-of-its kind agreement that represents a voluntary joint effort among payers to standard ize the way they finance, support and measure the delivery of Advanced Primary Care, a release said.
“This initiative builds upon a long history of stakeholder collaboration to improve the care and health of Californians and moves us from vision to action with aligned priorities
to scale high-quality primary care throughout the state,” says Crystal Eubanks, senior director of CQC.
“This initiative reflects our understanding that the impact of any one payer alone is limited,” says Peter Long, executive vice president of Strategy and Health Solutions at Blue Shield of California. “That’s why Blue Shield is committed to partnering with our peer payers and providers to scale delivery of highquality primary care across the state. Ultimately, we know this is what is best for our members, and we all must work together to make this vision a reality.”
California Advanced Primary Care Ini tiative stakeholders committed to pur suing the following goals in the MOU:
1. Transparency: Report primary care investment and adoption of value-based payment models that support the delivery of advanced primary care and performance on the advanced primary care measure set jointly developed by CQC and IHA, a list of metrics that enable purchasers, health plans and providers to identify primary care practices in a given market that are delivering the best results for patients.
2. Payment: Adopt an agreed upon value-based payment model for primary care providers that offers flexibility, supports team-based care delivery and incentivizes the right care at the right time.
3. Investment: Collaboratively set increased primary care invest ment quantitative goals without increasing the total cost of care.
4. Practice Transformation: Provide technical assistance to primary care practices to implement clinical and business models for success in value-based payment models, integration of behavioral health and reduction of disparities.
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Our nation needs better, safer, more effective medications.
By Dr. Robert PearlSince this time last year, the U.S. Food and Drug Administration (FDA) has granted approvals for 42 new medications. The press releases for these drugs would lead a reasonable person to conclude that a pharmaceutical revolu tion is underway – that the drug industry is ushering in a brave new era of medical advances.
The truth is far less flattering. Despite enormous hype and dozens of new medications flooding the mar ket each year, major pharmaceutical breakthroughs are exceedingly rare. The overwhelming majority of “block buster” drugs represent minimal (if any) improvement over existing treatments.
This is not because drug companies lack the scientific knowhow, research capabilities or dollars to deliver life saving medications.
Instead, drug-industry innovation has been stifled by an unwritten rule in healthcare; one that has guided nearly all pharmacological research and development (R&D) efforts of the 21st century.
In the previous century, before the term “wonder drug” was hyperbolically applied to every new FDA-approved medication on the market, drug companies almost always swung for the fences.
Consider the countless lives improved and saved by the true wonder drugs of the 20th-century.
Like insulin, discovered in 1921 to treat diabetes. Or penicillin, the infection-fighting antibiotic derived from mold in 1928. Or mechlorethamine, a 1940s weapon of chemical warfare turned cancer-fighting agent now used in chemotherapy drugs. Or the life-saving psychiatric
medication chlorpromazine, now known as Thorazine, created in 1951. Or birth control (approved by the FDA in 1960), or statins that reduce heart-disease (like Lipitor, patented in 1985) or the HIV/AIDS treatment zidovu dine (better known as AZT, 1987).
For each of these medications, the research and devel opment (R&D) process was intense and time-consuming. The go-to-market costs were massive with the potential to bankrupt the underwriting drug companies involved.
But despite the expenses and risks, pharmaceutical leaders were driven then by an intrinsic desire to save lives. As George Merck put it in 1950 near the end of his 25-year run as Merck CEO: “We try never to forget that medicine is for the people. It is not for the profits. The profits follow.”
From 1960 to 1980 prescription drug sales remained fairly static as a percent of U.S. gross domestic product, consuming just 5% of all medical costs.
Between 1980 and 2000, however, sales tripled. Today, prescription drug expenditures exceed $460 billion a year, accounting for 16.7% of all healthcare dollars spent.
In the 1980s, that outlook shifted. Newly elected president Ronald Reagan pulled back government regu lations, which sent the stock market soaring. Pharma ceutical shares skyrocketed more than 950% over the next 12 years.
By the 1990s, outsized CEO salaries and exorbitant drug prices had become the norm. The focus of the industry swung from saving lives to increasing shareholder value. Drug companies wanted to maximize prices while minimizing drug-development risks. They succeeded, and drug spending in the United States took off.
To spotlight the difference, consider that from 1960 to 1980 prescription drug sales remained fairly static as a percent of U.S. gross domestic product, consuming just 5% of all medical costs. Between 1980 and 2000, how ever, sales tripled. Today, prescription drug expenditures
exceed $460 billion a year, accounting for 16.7% of all healthcare dollars spent.
Pharma leaders love to trumpet how expensive and timeconsuming it is to bring a new drug to market. They col lectively assert that ever-rising prices are needed to “cover accelerated investment in researching and developing new and better medications to protect Americans.”
That message has found a receptive audience among patients. Today, 68% of Americans believe that the cost of R&D is “a major contributing factor” to high drug prices.
The data tell a different story about where the money goes. One report found that 9 of 10 top drugmakers spend billions more on marketing than R&D. Another investigation noted that 80 cents of every $1 in prescrip tion drug sales go to something other than R&D – be it profit, overhead, taxes, etc.
To be clear: Drug companies are not struggling to make ends meet or afford the cost of R&D. In fact, a 2019 analysis found that drugmakers could afford to lose $1 trillion in sales and still be the nation’s most profitable industry sector.
Two recent FDA approvals – Aduhelm, the first new Alzheimer’s medication in over two decades, and Tro delvy, a targeted treatment for aggressive breast cancer – demonstrate that drugmakers aren’t living up to their potential, despite the high prices and industry hype.
The companies behind Aduhelm and Trodelvy have issued a combined total of 70 press releases (34 from Biogen and 36 from Gilead) about their respec tive flagship drugs.
Notwithstanding the sheer quantity of promotion, neither drug will have a meaningfully positive impact on the lives of people with Alzheimer’s or breast cancer.
Look at Aduhelm. Two years before its approval, Biogen halted testing amid inconclusive and concerning results. In trials, the drug wasn’t shown to preserve intel lectual function for patients. But rather than abandoning the medication or pausing to invest in additional R&D, the company filed for accelerated approval, which the FDA granted against the cautions and protests of its sci entific advisory committee.
Upon approval, Aduhelm was projected to earn upward of $112 billion in annual sales with an initial price tag of $56,000 (five times greater than its estimated value) – a
maximal profit projection for a drug with minimal value. This controversial drug and its accelerated pathway to approval have Congress taking a closer look at the FDA. And for good reason. Since 1992, nearly half (112) of the 253 drugs given speedy approval have not been proven to extend longevity or improve quality of life.
And then there’s Trodelvy, a key drug in Gilead’s oncol ogy portfolio. It was invented by Immunomedics, Inc., which Gilead purchased for $21 billion (one of more than 30 cancer drugs Gilead has acquired in the past five years).
Priced at over $2,200 per vial, a 21-day cycle of the new breast-cancer treatment costs $16,000 and contrib uted to an 11% revenue increase for Gilead in 2021 (lead ing to a $19 million bonus for the company’s CEO).
and promote minimally effective drugs as if they were lifesaving medications.
Even the highly effective COVID-19 vaccines – the most celebrated innovation of the 21st century – were brought to market with minimal risk. The federal govern ment paid for much of the underlying development costs through decades of NIH-funded research and minimized the risks to companies by fronting $18 billion as part of “Operation Warp Speed.”
For drug companies, the lure of charging high prices ($2.1 million in one case) and generating huge profits (more than any other industry sector) distorts research priorities. As a result, pharmaceutical companies ignore many of the biggest areas of clinical need.
Consider antibiotics, a drug category that remains extremely under-researched and underfunded. Public health officials agree that antibiotic resistance undermines our entire modern medical system. Nationwide, drugresistant bugs are becoming a growing threat, putting mil lions of lives at risk. That is, unless drug companies can discover the next generation of treatments.
So, is Trodelvy worth the price? A company press release boasts a 49% reduction in the risk of death for patients who take the drug.
That figure is misleading at best. In studies, the medication extended median overall survival to 11.8 months compared to 6.9 months in the control group. The “statistically significant survival benefit” noted in the press release makes it sound as if patients taking the drug beat their cancer. In reality, they died less than five months later than patients who took standard chemotherapy.
When we zoom out and look at the 90-some new oncology drugs approved by the FDA this century, the average gain in life expectancy is a mere 73 days. Much of that time is spent in pain, dealing with debilitating side effects while being isolated from loved ones.
By following the rule of maximizing profits at mini mal risk, pharmaceutical companies now routinely price
But there’s a problem: Antibiotics are usually pre scribed for a short 10- to 14-day course, generating only a tiny profit. Thus, identifying a new class of antibiot ics is (financially) risky and nowhere as profitable as the drugs currently garnering the most interest – like cancer drugs, which can be priced at $120,000 to $150,000 a year regardless of efficacy.
Right now, more than 600 cancer drugs are being tested for clinical use. Meanwhile, there are no break through antibiotics on the horizon.
For the past two decades, life expectancy in the United States has stalled. Our nation needs better, safer, more effective medications. But drug companies won’t develop them until the industry inverts its focus: not on minimizing risk but on maximizing its impact on human lives.
Americans won’t be able to afford those drugs until another rule of the drug industry is broken: the rule gov erning how drug companies price their newest medica tions. That will be the focal point of the next article in the Breaking The Rules Of Healthcare series.
Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s a Forbes contributor, bestselling author, Stanford University professor, and host of two healthcare podcasts. Pearl’s newest book, “Uncaring: How the Culture of Medicine Kills Doctors & Patients,” is available now. All profits from the book go to Doctors Without Borders. For more information or to sign up for his newsletter, visit robertpearlmd.com.
Right now, more than 600 cancer drugs are being tested for clinical use. Meanwhile, there are no breakthrough antibiotics on the horizon.
In recent report, AHA says commercial health policies create significant barriers to patient care and unnecessarily spike administrative costs.
By Pete MercerPrivate commercial health insurance is a central component to the health insurance system in the United States, serving as the dominant source of health coverage for most Americans and employers. In addition to the prevalence of commercial health plans, Medicare and Medicaid programs often rely on private health insurance plans to administer their health benefits.
The American Hospital Associa tion (AHA) recently released a report – “Commercial Health Plans’ Poli cies Compromise Patient Safety and Raise Costs” – on the current state of the private commercial health insurance system. In this report, the AHA identifies the areas with the most opportunity for improvement.
Perhaps the most alarming revelation the AHA report discovered here is that health insurance policies dictate the bigger decisions regarding the care of a patient. The report says, “Some com mercial health insurers have imple mented policies that add billions of dollars in added unnecessary admin istrative costs to the healthcare sys tem while compromising patient care. Commercial health plan abuses must be addressed to protect patient’s health and ensure that medical professionals, not the insurance industry, are making the key decisions in patient care.”
The AHA said that commer cial insurance policies, like utilization management tools and prior authoriza tion requirements, create significant bar riers to patient care and unnecessarily spike administrative costs – while at the same time commercial insurance premiums have been steadily growing above the rate of inflation. Prices are up by 47% in the last 11 years.
Prior authorization requires physicians to submit their antici pated treatment plan to insurers and receive approval before they can move forward. Notably, not all treatments which have received prior authorizations will be cov ered by insurance. According to a previous study noted in the AHA report, physicians and staff spend as much as two days a week doing prior authorizations, a resourceintensive process, which contrib utes to physician burnout.
At the same time, prior authori zations can delay patient care, or even lead patients to switch treatment plans entirely. Around 82% of doc tors say that the prior authorization process has motivated their patients to drop anticipated treatment plans.
According to the report, massive administrative costs are due in
large part to the complex payment and reporting requirements of various commercial health insurers. They often include excessive and unjustified application of utiliza tion management tools and prior authorization requirements.
Oddly enough, commercial health insurers point to these processes and requirements as part of their efforts to manage healthcare spending. “What is often ignored are the complicated business and financial relationships between many health insurers and intermediary service providers,” the report says.
The AHA says that holding health plans accountable will alle viate the administrative process and services, all the while helping to improve care accessibility for patients and decreasing the burden on healthcare workers.
“We recommend identifying and measuring unnecessary administra tive costs because of health plan abuses and excessive requirements,” the report said. “Currently, much of this information is reflected in national datasets as spending on hos pitals, health systems and physicians because they are the ones who must absorb the cost of paying staff and acquiring the expensive products needed to comply with these com mercial health insurer policies.”
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Amid the pandemic, clinical visits for HIV, sexually trans mitted infections (STIs), and other evidence-based pre ventive services in the U.S. declined.
The American Medical Association (AMA) announced a new initiative aimed at addressing this issue by helping physicians and other health care professionals increase routine screenings for HIV, STIs, viral hepatitis and latent tuberculosis (LTBI).
As part of this effort, the AMA, with the support of the Centers for Disease Control and Prevention (CDC), worked to understand key barriers and drivers for imple menting routine screening and developed a toolkit to pro vide best practices and strategies to enhance screening pro grams. The AMA is collaborating with several community health center sites that will test the quality improvement strategies outlined in the toolkit to determine their impact on routine screening, as well as provide overall feedback on the toolkit before it is disseminated more broadly.
“Routine screening and early detection of HIV, STIs, viral hepatitis, and LTBI are critical to ensure patients receive treatment and also lower their risk of transmitting these infectious diseases to others,” said AMA President Jack Resneck Jr., M.D. “Given that access to preventive services were interrupted by the COVID-19 pandemic, many individuals may not even be aware they have an infection and are at risk of contributing to new infec tions. We know that social inequities and stigma continue to be barriers to screening. We believe this new toolkit will help increase screenings and prevent further spread of these infectious diseases. Additionally, with the monkey pox virus outbreak declared a public health emergency, the overlap in populations disproportionally affected, and the benefits of a syndemic approach, we look forward to the opportunity to work with the clinic sites in addressing this public health threat.”
Cancer has overtaken musculoskeletal conditions as the top driver of large companies’ health care costs, according to the Business Group on Health’s 2023 Large Employers’ Health Care Strategy and Plan Design Survey. While the top three con ditions fueling health care costs remained the same from
last year – they include cardiovascular disease, in addition to cancer and musculoskeletal conditions – 13% of employ ers said they have seen more late-stage cancers and another 44% anticipate seeing such an increase in the future, likely due to pandemic-related delays in care. A total of 135 large employers across varied sectors, who together cover more than 18 million people in the United States, completed the survey between May 31, 2022, and July 13, 2022.
ʯ
After experiencing no increase in actual health care cost from 2019 to 2020, employers experienced a sig nificant return to rising costs, with a median 2021 cost increase of 8.2%.
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Despite rising costs, employers expect to cover 82% of the cost of employee coverage in 2022, up from 80% the year before (employer support for fam ily coverage remains at 80% of premium). As costs increase, employers have been reluctant to shift costs to employees in the short-term and are looking at fun damental delivery system reforms, such as advanced primary care and centers of excellence for specific health conditions, to address unsustainable health care expenses and prescription drug costs.
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Large employers overwhelmingly (99%) said they were concerned about prescription drug trends. In 2021, prescription drugs accounted for a median of 21% of employers’ health care costs, with more than half of pharmacy spend going to specialty medications. Employ ers have opportunities to bring down costs through pharmacy program tactics, including biosimilar coverage, site of care and case management, among others.
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Long-term mental health issues, both observed and anticipated, are the leading health-related impact of the pandemic, employers said, with increases in medi cal services due to delayed care a close second. Some 43% have already seen this trend and another 39% anticipate such increases. In response, employers plan to keep many pandemic-related health and well-being offerings in place for the foreseeable future; 85% will do so for mental health.
A first-in-human multicenter trial involving Mayo Clinic used a new ablation technique for patients with ventricu lar tachycardia, an abnormally rapid heart rhythm that is a leading cause of sudden cardiac death worldwide.
The trial tested needle ablation using in-catheter, heated, saline-enhanced, radio frequency energy, also known as SERF, to substantially increase heat transfer, compared to conventional ablation methods. The new process produces deeper, controllable lesion scars at sites inside the heart muscle. The catheter can accurately con trol the ablation size and treat tissue that is deeper in the heart wall, which is where life-threatening arrhythmias that cause ventricular tachycardia are often found.
Therapies of medication and traditional ablation, which uses heat or cold to scar small areas of heart tissue, may not be enough to prevent ventricular tachycardia. Therefore, many patients also have an implantable cardio verter-defibrillator (ICD) to address dangerous arrhyth mias. While an ICD shock corrects the heart’s rhythm, it does not prevent arrhythmia. In the trial, researchers used several methods to directly eliminate abnormal heart tis sue that causes life-threatening rhythm.
“This preliminary trial is important because it sug gests that there is a new way to treat problematic ventricu lar tachycardia by reducing or eliminating the shocks that ICDs deliver. It appears to be effective in achieving this goal,” says Douglas Packer, M.D., a cardiac electrophysi ologist at Mayo Clinic, first author and principal investi gator of the study. “For clinicians, it provides hope that treatment in the electrophysiology lab may be effective, even if other treatments failed. For patients, it provides hope that their quality of life can be improved.”
The innovative catheter was developed by Michael Cur ley, Ph.D., of Boston-based Thermedical Inc., with funding from the National Institutes of Health (NIH). Dr. Curley is senior author of the research findings that are published in Circulation: Arrhythmia and Electrophysiology.
a randomized controlled trial,1 the effects of use of a MediHoney dressing were studied in patients with Type II diabetes and Wagner Grade 1 and 2 diabetic foot ulcers (DFUs) over a 16-week period.
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Marketing is a must for any company that not only wants to keep its head above water but wants to thrive in any economy. But like the economy, marketing best practic es don’t remain static. There is ebb and flow, depending on: ʯ The age of your target market ʯ World events ʯ The goals of your customers
To ensure you get the growth you want and avoid wasting time and money on ineffective marketing tech niques, we’re sharing tips in healthcare marketing. These tips will help you stay at the top of your customer’s minds and attract new ideal customers.
The advertising and marketing tactics of the 1950s and 1960s are not as effective in the 21st century. But even the tactics of the past few years can prove to be ineffective
and make your company seem outdated, which is why it’s vital to stay up to date on the latest marketing trends.
No. 1: Focus on Quality Rather Than Quantity
Yes, posting often is helpful. It can move your content up the Google chain and help put your content in front of your audience more often on social media.
However, if you post sub-par content just to post often, you risk your reputation. Potential customers might think that if healthcare suppliers are not willing to post quality content, why would they make quality physician office supplies, equipment, or PPE products?
Taking care to create quality blog posts, videos, and social media posts that are educational, informative, and appeal to your customer’s wants and needs can make your content stand out.
Each year, we hear of incredible innovations like AI assisting (or completely performing) with certain medi cal procedures, as well as technology that helps doctors and their teams educate patients in-office. Or next-gen eration applications like Infervision, which utilizes AI to help radiologists/doctors diagnose lung conditions faster, including cancer and COVID-19. Downloads of apps like this are expected to reach nearly 300 billion by 2023.
Your customers are interested in this technology. They know that utilizing it in their practices or hospitals can help them improve patient care and even see more patients each day.
Blogs, videos, or social media posts about the advance ments in healthcare can help you attract attention. Plus, you can impress your customers by providing useful, educa tional information about the technology they’re interested in, especially if it’s in easily digestible increments.
According to Hubspot.com, 97% of marketers state that video posts help them explain their products in a way that’s easier for their audience to understand.
Another benefit of video is that many people are visual learners. Reading blogs is helpful but when they see videos, they’re more likely to retain the information. Video is also a fast way to show the benefits or superiority of your products.
Keeping yourself and your marketing team up to date on the latest marketing practices can help improve your visibility. It will take some time and effort to learn the lat est best practices – but ultimately, it will be worth it!
Share Moving Media is a full-service media company that works with medical and healthcare suppliers. For more information, visit www.sharemovingmedia.com.
Taking care to create quality blog posts, videos, and social media posts that are educational, informative, and appeal to your customer’s wants and needs can make your content stand out.
Supply chain issues remain an ongoing concern for the healthcare distribution in dustry. In order to share information about these issues, HIDA convened a Shipping Work Group of supply chain and logistics experts among our member companies. This Ship ping Work Group has met on a monthly basis to provide an industry-wide perspective on the medical supply chain.
Federal Maritime Commissioner Carl Bentzel recently met with the Work Group to talk about challenges in the current shipping landscape:
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At any given time, there are 160 ships off the coast of the United States. This repre sents a 27% increase in volume, and volume is not expected to abate until 2024.
Staffing will be a key priority. Currently, the Commission has only 1 investigator for every $1 trillion in commerce. In comparison, the Securities & Exchange Commission (SEC) has 150 investigators for every $1 trillion.
ʯ Many of the provisions of the Ocean Ship ping Reform Act automatically went into effect when the bill was signed into law. This includes provisions to challenge unreason able fees on detention and demurrage – fees that exceeded $2 billion last year.
ʯ The FMC is now empowered to self-initiate investigations of ocean carrier business practices and apply enforcement measures.
Members of the Work Group shared addi tional observations:
By Linda Rouse O’Neillʯ
The size of ships is growing. Some now hold the container equivalent of 12,000 truckloads.
ʯ To visualize that cargo, consider this:
If a ship of that size is docked at the Port of Los Angeles, the number of trucks needed to unload it would form a line all the way to Las Vegas.
Fortunately, Commissioner Bentzel pointed to a new law passed by Congress, the Ocean Shipping Reform Act. HIDA supported pas sage of the Ocean Shipping Reform Act, and it was one of our key legislative priorities dur ing our annual Washington Summit in June. The new law empowers the Federal Mari time Commission (FMC) to combat unfair trade practices in the shipping industry and addresses price gouging on container shipping fees by ocean carriers.
ʯ The new law gives the FMC additional resources for enforcement and investigations.
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At the Port of Long Beach, the number of “long-dwell” import containers (waiting at terminal 9 days or more) is at the highest level since October 2021.
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Rail freight delays are making container backups at the ports worse. At the Port of Los Angeles, there are about 35,000 containers designated for rail on the docks. A normal day looks more like 9,000 units.
ʯ Labor issues are an ongoing concern at West Coast ports – across all modes of transport. Contract disputes and work stoppages have roiled truckers, dockworkers, and railyard workers.
Both the insights of our members – and the opportunity to interact with federal part ners such as the FMC – enables HIDA to bet ter advocate for the interests of our industry. As we continue to unwind the bottlenecks in the medical supply chain, HIDA will remain at the forefront of these issues.
Linda Rouse O’Neill, Vice President, Supply Chain Policy & Executive Branch Relations
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For Henry Schein’s Doin Dahlke, the skills he developed as an athletic trainer have carried over to a successful sales career.
By Graham GarrisonGrit. Drive. Hard work. When you list those intangibles, you could be talking about sports, or you could be talking about what it takes to be suc cessful in sales.
For Henry Schein’s Doin Dahlke, the tie-ins have led to a successful career in both pursuits – first as an athletic trainer, and currently as a regional sales manager in the com pany’s Athletics & Schools business.
In 1988, Dahlke received his certification as an athletic trainer. Dahlke was a head trainer for Divi sion II college athletics for 10 years, then worked for orthopedists who focused on assisting high school ath letes. He would eventually start his own business, providing functional capacity evaluations in Arkansas.
“I then took a sales position with [a local company] where I worked
for 14 years. While there I met Lisa, my inside telesales rep from Henry Schein. I sold orthopedic knee braces, and called on, and sold to, ortho pedic clinics and colleges. Then I moved total joint surgical sales.”
Dahlke started at Henry Schein right before the pandemic, but has made an immediate impact. In 2021, he was named salesperson of the year for Henry Schein’s Athletics & Schools business.
So, what’s been the key to success for Dahlke? A lot of it has to do with transferable skills.
Athletic trainers must have a tre mendous work ethic to be success ful. For instance, when Dahlke was an athletic trainer for a college, he was at work by 6:00 a.m. doing rehab, treatment, and covering practices. He would also work night events. “A lot of times athletic trainers put in 16 hours a day, and work 80 hours a week,” he said. “So, they’re always hardworking.” At Henry Schein, Dahlke is either at his desk relentlessly working the phones on quotes, bids or problem solving, or he’s out on the road covering North Texas, Louisi ana, Arkansas, Missouri, Oklahoma, Kansas, Mississippi and Alabama.
Athletic trainers must be person able, because they deal with a lot of different people. The ability to com municate and develop relationships is another commonality between the two worlds. Athletic trainers are
unique because they can talk the language of a neurosurgeon or an orthopedic surgeon. “And if you’ve been to the doctor, most of the time they like to talk in big words, and a lot of patients or outsiders don’t understand them. But [athletic train ers] can turn around and convey what that doctor said to an eighthgrade kid or a parent.” Sales, too, is 100% about relationships. If you don’t have relationships and can’t communicate with people on their level, you won’t be successful. Sales reps can also speak and understand the medical lingo while working well with those handling the deliveries or factory lines, Dahlke said.
In his spare time, Dahlke contin ues to work as an athletic trainer at
Professional Bull Riding (PBR) competitions. He’s been covering PBR events for the last seven years and rodeo events for 35 years. He
and two other trainers and an ortho pedic surgeon are on-hand to take care of injuries. Just about every weekend he will fly somewhere. “Last week, I was in Kansas City, Missouri,” he said. “I got there Friday afternoon, covered those events and came home Sunday – back to work.”
For Dahlke, whether it’s wrap ping up a sale or wrapping the rolled ankle of a professional bull-rider, the action never stops. That’s just the way he likes it, and it ties into the final transferable trait between both pro fessions – the desire to win. “Athletic trainers are with a team, or you’ve got a vested interest in a sport most of the time you’re in it,” Dahlke said.
“You’ve got that desire and burn to win. [In distribution], you’ve got to win that sale or you’re not going to be successful.”
The main job of the sales rep is selling. Who would argue with that? But the question is, What’s the best way to do it? Author, trainer, podcaster and speaker Mace Horoff summed it up at the 2022 IMDA/HIRA Annual Conference this summer in suburban Chicago: Be. Relevant. Now.
an orthopedic salesperson, he needed a minivan to accommodate the cases and trays needed for the day’s pro cedures. He approached one dealer who, upon learning Horoff’s desire for a minivan, immediately demon strated the luxury features and other amenities of one model. But another salesperson, at another dealer, first asked WHY he was looking for a minivan. Was it for comfort, travel ing, cargo? When Horoff told him his need, the salesman focused on the ease with which Horoff could easily create space in the back of the van by folding down seats, etc.
Space was what was relevant to the customer. That salesperson knew that, and that’s what he addressed. And the sale was made.
Horoff was the keynote speaker for the 2 ½-day conference for members of the Independent Medi cal Specialty Dealers Association (IMDA) and the Health Industry Representatives Association (HIRA), as well as for manufacturers of inno vative medical products looking for specialty representation.
Horoff called for sales reps to step out of the “sea of sameness” into the “pool of distinction.” It’s done by talking to the customer or prospect about what’s important to
He called it “real-time relevance,” that is, demonstrating to prospects how your product intersects with the issues they want to solve or address NOW. It could be time-savings, risk reduction, cost reduction, revenue generation, improved patient out comes or satisfaction, or simplifying work processes in the practice.
There’s only way to attain realtime relevance, he said: Ask ques tions. Horoff shared an anecdote to demonstrate the point: Years ago, as
Some of the most important things happen at intersections, that is, those places where people, things, ideas and objectives come together. In healthcare, value analysis profession als stand at one of those intersections – where best outcomes meet lowest overall cost, said value analysis and materials management experts Bar bara Strain and Dee Donatelli at the 2022 IMDA/HIRA conference.
Value analysis professionals work at the intersection of clini cal operations, high-cost procedure areas, nursing, materials manage ment and operations. They know what contracts are in place at their health systems and what objectives suppliers can realistically achieve within the contract parameters. After a contract is signed, they can aid the supplier in conversions, and further down the road, they can help address issues such as recalls or backorders. With the supplier, value analysis can monitor contract compliance to ensure that the contract is a “win” for both sides.
Working at the intersection depends on communication, said Donatelli and Strain. Unfortunately,
even now, two and a half years after the beginning of the COVID pan demic, many value analysis profes sionals are still tied up resolving product sourcing issues. They may not answer suppliers’ calls promptly. “They are inundated,” said the two speakers. “But they do care.” Their advice to suppliers with innovative technologies? Keep calling.
How can sales management encour age reps to truly grow? It starts with a mindset. For IMDA member Sovereign Medical, Hillsborough, North Carolina, that mindset goes something like this: “We never fail. Instead, we learn.” And it is an
integral part of sales training and everyday interactions.
New things (case in point, COVID-19) are continually hap pening, and reps must adapt accord ingly, Sovereign’s Jennifer Lynch and Chris Lowry told attendees at the IMDA/HIRA conference. Obsta cles are opportunities. The manag er’s challenge is getting everyone in the company to think in those terms. They can do so through education, collaboration and celebration.
“We are looking for a marriage of old and new sales practices,” they said. Persistence and the will ingness to try new things bring results. And successes are to be celebrated. “That’s the fun part,” they said.
The people at Sovereign believe that writing down and referring to a cultural philosophy is important for any successful business and can be an integral part of the mind set of growth. It facilitates clarity and focus, and answers vital ques tions, such as: “How do we want our company to be perceived by the public, our customers and our own team?” “How do we want our people to feel about being part of this company?”
Even for CFOs, it’s about more than numbers
Healthcare is a risky business, par ticularly now, given inflation, mon keypox, COVID-19, labor shortages of epic proportions, ransomware attacks, supply chain backups, and shrinking operating margins. To today’s healthcare CFO, almost every move forward is a bet, a gamble, speaker Todd Nelson, chief partnership executive for the Healthcare Financial Management Association, said at the IMDA/ HIRA conference. But it takes uncertainty to shake things up, and that could be an opportunity for specialty dealers and reps.
For CFOs, the bottom line has always been about minimizing the cost of delivering optimal health outcomes, he said. It’s bigger than trying to lower the purchase price of supplies and equipment. After all, social determinants of health – poverty, food deserts, violence, inadequate housing – contribute an estimated 60% to health status, compared to health services, which contribute about 20%, and genet ics, another 20%. So as providers work to address their own labor and non-labor costs, they’re also ques tioning to what extent they should address the economic stability of
the patients in their communities, including education, transportation, housing and more.
Given all that is on the minds of CFOs, specialty dealers need to keep the following in mind, said Nelson. First, it takes time to develop a rela tionship with a CFO. So be patient; understand and acknowledge the pressures facing the CFO and the health system. Second, respect the time of the CFO. (Be brief!) And third, be ready to articulate how you, your company and your products create value, e.g., quality, cost, avail ability, time-savings, etc..
Finally, specialty dealers should be ready to identify the nonfinancial benefits of their company and technologies:
ʯ Will their technologies contribute to community health wellness?
ʯ Will they enhance the image and reputation of the health system?
ʯ Can they help the health system increase market share?
ʯ Will they help lead to improved outcomes?
ʯ Can they contribute to physician and clinician satisfaction with the health system?
ʯ Will they contribute to the pro vider’s risk-reduction efforts?
Sure, numbers are important to CFOs, said Nelson. But so are intangibles.
Providers are reconsidering their mission and focusing on their role in the prevention of disease, well ness, and disease management, said Maria Hames, partner, Healthcare Links, a national accounts consult ing firm, at the IMDA/HIRA con ference. And suppliers need to step
up. She listed some of the changes of attitude that COVID-19 has precipitated among supply chain executives to which specialty deal ers and reps should be attentive. They include:
ʯ
A more serious look at “made in USA” technologies (while balanc ing cost with risk mitigation).
ʯ
Concern about sole-source or lim ited-source relationships. (Given the product shortages of the past two years, providers are wary of getting burned again.)
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Redefinition of the traditional relationship between sales rep and customer. (Zoom calls are probably here to stay, and reps must hone their on-screen skills. That said, it’s unlikely virtual calls will occur as frequently as they did at the height of COVID-19.)
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Labor shortages among clinical and non-clinical workers alike, which are taxing processes and people – i.e., customers and potential customers – in the health system.
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Skepticism about “just-in-time” programs, which is leading supply chain executives to take another look at consolidated service centers.
ʯ
A serious look at taking inhouse some of the “non-core services” providers outsourced over the past decade.
ʯ Continued emphasis on reducing variance in the medical proce dures their clinicians perform and the supplies and equipment they use for them.
For sales reps, it’s an opportunity to distinguish themselves through strategic selling. But they must pro duce evidence to prove the value of their products and services.
Time management is crucial to the success of any role in sales. There are only so many hours within a week, and so many of them are wasted because sales reps aren’t effec tively prioritizing their time. According to Falon Fatemi, a contributor to Forbes, there is an art and a science to effec tive time management
Fatemi writes in Forbes, “The most effective sales people are time management czars. Their discipline and focus gifts them with additional hours each week to focus on high-impact revenue-generating activities and enables them to stand atop the leaderboard.”
The reality is that time management has more to do with the body’s internal clock than a compilation of to-do lists. Fatemi cites Daniel Pink’s book, When: The Scientific
Secrets of Perfect Timing, saying there is “extensive research to support the fact that humans experience three distinct phases of productivity throughout the duration of each day: a peak that occurs in the morning after waking up, a trough that occurs in the afternoon, and a rebound that transpires in the evening.”
Because sales reps are highly analytical people, they draw on their analytical skills throughout the entire sales cycle – from the early prospecting process to the close. Because of this quality, Fatemi argues that sales reps should schedule analytical tasks such as lead scoring, pipeline tracking and management, sales forecasting, and acquiring new knowledge during their peak period in the morning. “Night owls, on the other hand, should schedule their most analytical and logic-oriented work in the eve nings when they reach peak levels of alertness and focus.”
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If your sales team is underperforming, know that they are not alone. A Hubspot survey found that 66% of sales people are not reaching their quotas. That could be for a number of reasons: lack of proper training, no definable sales process, bad company culture, or they just aren’t cut out for sales. Whatever the reason may be, there’s always a way to fix it. Here are some sales management strategies to boost the performance of your sales team:
If you want to help your sales team reach peak perfor mance, don’t let one-on-one coaching fall through the cracks. Regular coaching is integral to your team becom ing more productive, confident and skilled at sales. Coach your sales reps through a variety of customer interactions, giving them a greater arsenal to work with in difficult situ ations and a better opportunity to close more deals.
No two companies will have the same sales process, but it’s important to have a process in place that equips your sales reps with the proper tools and information they need to reach their sales goals. A playbook can
take the processes of your top performers and share those tactics with your underperforming sales reps. This will streamline the whole process, making it more effi cient, productive and consistent across your entire team.
Establishing a good, healthy company culture is key to the success of your business. Whether you are creating a positive physical and social environment or celebrat ing employee achievements, your team needs a culture that will allow them to thrive. Provide them with a flex ible work schedule (which could include allowing them to work from home), offer professional development, or drive engagement with events and competitions for your team.
Managing a sales team can be challenging even in the best of circumstances, especially when you are trying to drive growth for your organization. As the lifeblood of your company, the sales team needs an effective manage ment team to steer the boat in the right direction. Here are three tips for managing a successful sales team from Sales Hacker:
No. 1: Be results oriented
Hiring people with drive and determination is a great way to build a sales team. But even drive and determination can wane over time. Focusing on the results of your sales tactics will help your team to distinguish the difference between activity and productivity. A strong sales team will drive the entire organization to profitability.
No. 2: Manage expectations
Managing expectations in a sales environment is a signifi cant part of keeping morale up around the office. One of the first lessons you learn in a sales environment is to take rejection in stride, knowing that it’s just part of the job. Managing expectations helps your sales reps to understand that they won’t land every deal and might not even hit their quota every single month.
With a high sales goal, your reps will have something worth pursuing. But it also needs to be achievable, which will help to bolster their efforts to hit the goals each week, month, and year. If you achieve only 70% of a stretch goal, you’re doing better than achieving 100% of a mediocre goal.
Food for your thoughts
“All big things come from small beginnings.”
James Clear, author of “Atomic Habits” “Change is inevitable. Growth is optional.” – John Maxwell, business author and speaker “The obstacle in the path becomes the path. Never forget, within every obstacle is an opportunity to improve our condition.”
– Ryan Holiday, author of “The Obstacle Is the Way: The Timeless Art of Turning Adversity to Advantage”
Owens & Minor Inc. and Minneapolis, Minnesota-based Allina Health an nounced in August their renewed part nership and plans to create what they called a “unique integrated service model for supply chain resiliency.”
The integrated service model is an evolution of the 20-year partner ship between the two. At its heart is an integrated service center, which will serve as the hub and central command for supply chain opera tions, combining communications, fulfillment, inventory management and distribution for Allina Health’s 10 hospitals and its clinical care net work, including 6,000 associated and employed physicians.
“Over the course of our stra tegic partnership, Owens & Minor
has worked closely with Allina Health to more deeply understand the sys tem’s evolving needs and obsta cles,” says Jeff Jochims, EVP, chief operating officer and president, Products and Healthcare Services, Owens & Minor. “In this next phase of our collaboration, Owens & Minor and Allina Health have committed to expansive data shar ing and analytics.”
Owens & Minor will continue to serve Allina Health from its estab lished distribution center just out side Minneapolis, while collaborat ing with the health system to design a new, integrated service model that more broadly supports the opera tional needs of both Allina Health and Owens & Minor, Jochims says.
“We welcome the opportunity to work more closely with a partner as forward-thinking as Allina Health to not only drive greater efficiencies, but also to collaborate on new ways to support the continued health of their supply chain operation.”
“Allina Health believes that deepening our successful relation ship with Owens & Minor will ele vate our ability to ensure that our providers and clinical staff have the products they need, when they need them,” said Thomas M. Lubotsky, vice president of supply chain, Allina Health. “Further combining our collective strengths is key to our vision for exploring creative, inno vative ways to improve our supply chain operations.”
Cardinal Health has announced that its Board of Directors has elected Jason Hollar as the company’s next chief executive officer, effective Sept. 1, 2022. Hollar joined the board of directors effective Aug. 11, 2022. Hol lar succeeded CEO Mike Kaufmann. Hollar, an experienced financial and operating executive, has served as Cardinal Health’s Chief Finan cial Officer since May 2020, leading financial activities across the enter prise, including financial strategy,
capital deployment, treasury, tax, investor relations, risk management, accounting and reporting. During his tenure, he has helped Cardinal Health prioritize investments in growth businesses, strengthened the balance sheet, and returned capital to shareholders. Prior to joining Cardinal Health, Hollar served as chief financial officer and executive vice president for Ten neco. Before that, Hollar served as chief financial officer and senior vice president of finance for Sears Holdings Corporation.
In addition, Patricia English will serve as Cardinal Health’s interim chief financial officer, working with Hollar to ensure a smooth transition. English cur rently serves as chief accounting officer and senior vice president of Cardinal Health and previ ously served as vice president of accounting in both the pharmaceu tical and medical segments. Cardi nal Health’s board will engage an executive search firm to evaluate candidates for the permanent chief financial officer position.
The HHS, through the HRSA, announced investments of nearly $60 million to grow the health work force and increase access to quality health care in rural communities, including nearly $46 million in fund ing from the American Rescue Plan.
Nearly $46 million in American Rescue Plan funding will support 31 awardees to expand health care capac ity in rural and tribal communities through health care job development, training, and placement. This fund ing includes support for critical health workforce needs in rural areas such as dental hygienists, medical or dental assistants, community-based doulas, and other frontline health care workers.
Nearly $10 million will support 13 organizations through the Rural Residency Planning and Develop ment Program to establish new med ical residency programs in rural com munities to increase the number of physicians training in rural settings. In addition, nearly $4 million will support 18 awards to improve patient health outcomes and quality and delivery of care throughout rural counties and improve access to care for rural veterans.
In August, Health and Human Services (HHS) Secretary Xavier Becerra said the agency has declared the monkeypox outbreak a public health emergency. The administra tion’s announcement follows similar decisions by health officials in New York, California and Illinois and global health leaders. The WHO on July 23 declared that monkeypox was a public health emergency of inter national concern, its highest-level
warning, after confirmed outbreaks in about 70 countries where the virus has not historically spread.
BD announced Puneet Sarin has been named president of BD Medication Management Solutions, and Steve Conly has been named president of BD Biosciences, both effective Oct. 3. In these roles, Sarin and Conly will be responsible for driving global strategic, operational and commercial performance of their respective busi ness units. Sarin will report to Mike Garrison, executive vice president (EVP) and president of the Medi cal segment, and Conly will report to Dave Hickey, EVP and president of the Life Sciences segment.
Henry Schein announced the 25th anniversary of its “Back to School” program, which provides backpacks, school supplies, and more to sup port the back-to-school needs of underserved children and their fami lies. Since the program’s inception in 1998, the Company has helped more than 65,000 children start a new school year with confidence.
This year, Team Schein Members at 34 locations, including 21 U.S. facili ties and 13 international sites in five countries (Canada, Ireland, Italy, Spain, and United Kingdom), are donating backpacks filled with school supplies to more than 5,000 children. At each Henry Schein location, teams work with local social service agencies to identify participating children and their families. The “Back to School” program is a flagship initiative of Henry Schein Cares, the Company’s global corporate social responsibility program.
“Over the past 25 years, the ‘Back to School’ program has continued to grow and evolve, helping to meet the ever-changing needs of the commu nities in which we live and work,” said Stanley M. Bergman, Chairman of the Board and Chief Executive Offi cer of Henry Schein. “Our inaugural program served 175 children, and the Team Schein spirit has remained strong since the beginning, with Team Schein Members joining all over the world to help furnish children with the essentials needed to have a suc cessful school year.
In the latest episode of #schein chats, Henry Schein’s signature social media series, Dan LaRosa, Senior Manager of Team Schein and Com munity Services at Henry Schein, sat down with Fran Mellow, Division Director at Family Service League, New York, to discuss how the “Back to School” program helps enhance access to essentials, why starting the school year off with confi dence is important, the effects of the COVID-19 pandemic, and what companies can do to build similar initiatives. Watch the discussion here.
“No parent or guardian should have to face financial pressure and struggles in trying to meet what are essential costs for their child’s educa tion. And no child should feel anxiety about the price of school supplies,” said Suzanne Connolly, Chief Execu tive Officer of Barnardos Children’s Charity, Ireland. “At Barnardos, our mission is to deliver services and work with families, communities, and our partners to transform the lives of vulnerable children who are affected by adverse childhood experiences. By collaborating with Henry Schein to support the back-to-school needs of vulnerable children, we can help them achieve great things, because childhood lasts a lifetime.
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