REP Sept 20 by BOC design Inc

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Brace Yourselves Distributors, manufacturers and supply chain teams across the country were hard at work preparing for the upcoming respiratory season.

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SEPTEMBER 2020 • VOLUME 28 • ISSUE 9

PUBLISHER’S LETTER View from the Field........................2

DISTRIBUTION 2020: A Wild Ride Distributor reps across the country discuss their year-to-date, and their expectations for the rest of 2020............... 4

PHYSICIAN OFFICE LAB What about Wearables? How wearable technology could lead us into the future of healthcare.......... 8

IDN OPPORTUNITIES

Brace Yourselves Distributors, manufacturers and supply chain teams across the country were hard at work preparing for the upcoming respiratory season.

REP Corner Jordan Scott

Breaking Down Siloes Collaboration between Supply Chain and IT helped one health system streamline its contracting following a merger............12

TRENDS Selling to a Stressed-Out World..................... 30 Diversifying the Supply Strategy When member needs outweighed current contracted supplies, Vizient approached one manufacturer about a unique way to quickly scale to meet demand.......36

Combating COVID with Data The Collective and Augmented Intelligence Against COVID-19 (CAIAC) alliance....................................38

SALES 5 Ways to Work Smarter, Not Harder in Healthcare Sales............................. 42

Healing Hearts How a medical diagnosis for one of her children was a springboard for Diane Feinauer into the medical community.

SMART SELLING

NEWS

Turn to ‘TED Talks’ for sales call inspiration during COVID-19............................. 52

HEALTHY REPS Health news and notes.............. 54

WINDSHIELD TIME Automotive-related news....... 56

A Continuation AHA report: financial impact of COVID-19 expected to top $323 billion in 2020.........58

Walgreens announces large-scale rollout of physician-led primary care clinics.......................................... 59 Industry news................................... 60

repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2020 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.

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September 2020

PUBLISHER’S LETTER

View from the Field Had this year gone to plan, I should have been booking my flight to HIDA right about

now and getting geared up for selling season, as well as setting up travel to do year-end reviews and start pitching 2021. But it’s 2020, and the hits keep on coming! Before I go too far, let me just say I miss seeing you all at meetings and events.

Given our new normal, I decided to interview several distribution reps and two managers across the country to hear what you guys are seeing out there. The overall vibe with distribution? Very positive, even though everyone has been burning the candle at both ends.

Scott Adams

One thing that came from every conversation was the new way of selling. Yes, I am talking about virtual sales calls and digital pitches. Each rep and sales leader I spoke to told me if we built short, end-user videos, they would 100% use them to pitch end-users on products. The year started out on fire from a sales perspective, then burnt down in March/ April, and in May/June rekindled to typical sales. The outlook for July through

September was positive. You can read the full article beginning on page 4. One thing that came from every conversation was the new way of selling. Yes, I am talking about virtual sales calls and digital pitches. Each rep and sales leader I spoke to told me if we built short, end-user videos, they would 100% use them to pitch end-users on products. We have already started building these for manufacturers and will host them in RepConnect. As always, we wake up every day with one goal in mind: how can we help distribution reps sell more while improving outcomes and taking care of the caregivers? If you have specific manufacturers or products you’d like to see us build videos on, please let me know: sadams@sharemovingmedia.com Dedicated to the industry, R. Scott Adams

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

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2020 editorial board

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Eddie Dienes: McKesson Medical-Surgical

Scott Adams

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Richard Bigham: IMCO Joan Eliasek: McKesson Medical-Surgical Ty Ford: Henry Schein

acherry@sharemovingmedia.com

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Bob Ortiz: Medline

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September 2020

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DISTRIBUTION

2020: A Wild Ride Distributor reps across the country discuss their year-to-date, and their expectations for the rest of 2020. By Scott Adams

“For the first time in my career, I feel like I’m making a difference in the lives of Americans,” one rep told me dur-

ing a recent conversation. The comment caught me a little off guard because of who it was coming from – a 20-plus year veteran of the industry, who has made all kinds of contributions to his organization and the med/surg community overall. “I always felt like I made a difference, but now I know I am making a difference by getting people gloves and COVID testing and all the stuff they need right now.”

I wanted to explore this idea further, so over the last several weeks I reached out to a half dozen sales reps and sales leaders from national and regional distributors to give them an open forum. I asked them about the first half of the year, whether their accounts were allowing vendors back in, the PPE situation, and their hopes for the rest of 2020. The following are insights from those conversations:

Year-to-date If 2020 was a pendulum, it might be in danger of breaking with all of the wild swings it has incurred through the first six months. 4

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I asked each individual to walk me through their year-to-date. Despite being spread across a wide range of regions throughout the country, what they told me was very similar. It was almost eerie, like they were singing from the same hymnal despite not knowing one another. The first quarter was record-setting for almost every individual. I heard eye-popping numbers from several reps who were well over 100% January through March. “We were on fire,” one sales leader told me. Then came the spring. March and April were like “someone turned the water off,” one rep told me. Reps that were on record-setting pace saw sales dip to 60% of their budget, or worse. It

DISTRIBUTION really varied, but it was all well below budget for everyone. Physician offices, pediatric offices and specialty centers were simply shut down. Healthcare, besides COVID care and emergencies, was not happening. Fortunately, sales began to creep back up in May as some physician offices and specialty centers reopened. I heard from many reps that June started to feel more normal, and they were optimistic about July and August.

Calling on accounts Calling on accounts was a mixed bag for the reps I talked with. Some reps were able to call on accounts, while some customers still had not opened their doors to vendors. One problem reps are running into with accounts is the request for certain PPE items from providers who never used them before. Think specialties like ortho and OB/GYN, or even pediatric offices. They may have used them in a limited capacity before COVID-19 hit, but now through state mandates and their own precautions they are putting in requests for these PPE items in record numbers. One rep talked about a large health system shutting down some of its practices, including family practices, but they are expanding and still in building mode for specialties. That will be something to watch.

Collaboration Distributor reps and their manufacturer partners are having to rethink how they work together. It’s still difficult to do ride-days, and we don’t know for sure when that will change. That’s why it’s important for manufacturer reps to utilize things like video support and being efficient in how they handle calls via Zoom or Microsoft teams.

New ways to sell. New things to sell. If you are a rep, you must be thinking outside the box. Think about selling things you’ve never sold before. What items can help a practice with infection control protocols and rapid testing? Think of different ways to sell. Tools like manufacturer videos or Zoom calls will be critical for the foreseeable future. The good, progressive reps I talked to are not only surviving, but thriving. They’re using different technology, thinking outside the box and thinking about selling different things to different types of accounts like university systems and boarding schools. There are so many new markets that haven’t purchased PPE before. Think of a barber shop and masks and gloves. 6

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Caregivers have to get ahead of their COVID test orders Physician offices that aren’t testing for COVID now may regret it later, according to the reps I spoke with. If a physician office is sending patients out for COVID testing, what’s stopping those patients from finding another provider who is or will be providing COVID testing at the office? Convenience and trust with the practice will come into play. Practices that aren’t doing COVID testing in the summer may be in trouble come fall when we get into respiratory season just by sheer demand. Their patients will not want to come to a practice that sends them away when they’re sick.

The good, progressive reps I talked to are not only surviving, but thriving. They’re using different technology, thinking outside the box and thinking about selling different things to different types of accounts like university systems and boarding schools. Plus, the reps and sales leaders I talked to said reimbursement on COVID testing is good. If providers wait too long to make their orders, there will be allocation on this stuff like everything else, and if you weren’t already buying you may find it difficult to suddenly sign up and have access to it. When it gets CLIA-waived, COVID testing will be very interesting to watch. It could be in every hotel and before people board a cruise ship.

Morale The people I talked to were more positive than I had anticipated. They’re exhausted, of course. All of them are working crazy hours. They’re spending a lot of time chasing down allocation and PPE, but despite those dynamics, the reps and sales leaders I talked to remained positive. Maybe the right word is determined. They’re making a difference and it shows.

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PHYSICIAN OFFICE LAB

What about Wearables? How wearable technology could lead us into the future of healthcare. If you perform an internet search on wearables, you will find references going back to the 13th century with the

first eyeglasses. In the timeline there are classics including calculator watches and Bluetooth earpieces, and less notable items including the sneaker phone and airconditioned top hats. Trying to separate the innovations from fashion fads and out-of-control technology has fascinated me since I put on my first “fitness tracker” 10 years ago.

This month I will take you on a journey and breathing routines and more. Though I to think about wearables and how they fit into have used a fitness tracker for over 10 years, the world of healthcare today and tomorrow. I’ve frequently described wearables as technolThere will not be an update on where to buy ogy designed for the worried well(thy). They the latest sneaker phone. I plan to use my seemed cater to a pretty specific sub-set of By Jim Poggi insights on how healthcare and wearable techAmericans: those who cared about their fitnology have evolved and intertwined so far and ness level and wanted to actively participate in consider what I believe to be some useful possible appliimproving it with wearable technology. cations of wearables for the future. I encourage you to With type 2 diabetes, obesity, and uncontrolled hyperput your imagination to work and think along with me: tension all increasing and negatively impacting the health what about wearables? of Americans overall, I’ve felt that most Americans who Wearable fitness trackers have evolved from simple wore them had a fashion statement in mind rather than devices that measure your steps to devices that now health and fitness improvement. Granted, there is a comtrack your steps and daily activities and can also perform mitted group who use their wearable device to improve a one lead ECG, recommend exercises and fitness routheir overall health, fitness and even train for athletic tines, track and trend pulse rate, cheer for you when you events. But, even with smartphone applications providshow progress against fitness goals, provide meditation ing a remarkable range of data element tracking options 8

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PHYSICIAN OFFICE LAB and sophisticated interpretations of the data, wearables have not yet found their larger mission in healthcare. They were technically interesting, provide a definite coolness factor, and have proven to influence behavior for committed individuals, but I did not see them influencing improvements in overall health for the general population. I have changed my mind.

Imagining the possibilities However, everything changed when I saw the first continuous glucose monitoring systems coupled with smartphone and wearable technology. The benefits were impressive: instant and continuous feedback on glucose levels, no fingersticks, a wearable sensor that lasts for days and sends data to the manufacturer’s monitor or a smartphone, and greatly improved comfort and convenience for the users. Just getting rid of the pain and inconvenience of fingersticks is a big leap forward. And these devices have been shown to provide information and feedback that results in better control of both glucose levels and A1C.

What if a wearable could monitor blood pressure in real time and provide feedback? What if it could also administer medication as insulin pumps do? What could the future of hypertension look like? Overall, this is an impressive step forward for patients with diabetes. It has the potential to reduce morbidity and mortality associated with diabetes and improve patient lives, the patient experience and improve overall health – all because of the continuous data stream, ease of use and integration with smartphones that have become part of our daily life and greater convenience and less pain through replacement of fingerstick technology with a wearable sensor. As I reflected on the innovation provided by the wearable sensor technology coupled with smartphones, I began to wonder where the path of wearable technology could lead us in the future of healthcare. Could it be harnessed to target morbidity and mortality associated with chronic disease states, help with anxiety and depression, or alert us to the earliest stages of an infection? What unmet needs could this technology fulfill? 10

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I’ve put some thought into how wearable technology could provide tangible benefits to the healthcare system by providing actionable data that influences diagnosis, monitors data related to a chronic condition (such as our diabetes example), speeds the path to care or even uncovers an underlying condition before it becomes obvious. Here are a few possibilities that intrigue me. I encourage you to harness your imagination and come up with your own list of possibilities.

Improving hypertension control According to NIH/NCBI data, hypertension effects 32% of adults in western society, accounting for over 8.5% of all physician office visits. Over 50% of all hypertensive patients are considered poorly controlled. Finally, hypertension is linked to heart disease, stroke, and kidney disease, all of which are among the 10 leading causes of death in the United States. What if a wearable could monitor blood pressure in real time and provide feedback? What if it could also administer medication as insulin pumps do? What could the future of hypertension look like?

Infection COVID-19 has led to widespread use of non-contact infrared thermometers, but they don’t provide continuous monitoring of body temperature for the individual patient. What if there was a sensor in the ear or elsewhere connected to real-time temperature monitoring and reporting? Could respiratory infections be caught earlier? Could we reduce the incidence of sepsis? Could ER diagnosis of patients take place before widespread infections took place?

Neurological disorders Narcolepsy, seizure disorders and other neurological disorders involve changes in the patterns and transmission of brain waves. Some animals, including dogs, can become alert to seizures in their earliest stages. So, there is something here that can be measured. What if wearables could track these changes and provide an alert before the neurological disorder results in a seizure or the patient sleeping inappropriately? I find the potential of wearable technology coupled with knowledge of which clinical conditions are subject to assessment by real-time monitoring to be an area of technology and healthcare on the verge of fundamental changes. I have my shortlist of conditions where I see opportunity for improvement. What is on yours?

SNIFF STREPPY

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IDN OPPORTUNITIES

Breaking Down Siloes Collaboration between Supply Chain and IT helped one health system streamline its contracting following a merger. By Graham Garrison

Implementing standardization across an organization following a merger of two entities can be challenging.

Jordan Scott, MBA, Supply Chain – IT Program Manager at HonorHealth, has another term for it – natural turbulence. HonorHealth was formed by the merger of John C. Lincoln Health Network and Scottsdale Healthcare in 2015.

“As expected, there was natural turbulence during the forming and storming phases of our organizational development,” he said. However, through an extensive integration process, IT and Supply Chain identified duplicate software, hardware and service contracts at different price points that were in place pre-merger across the organization. “This ultimately led to the renegotiation and termination of 50+ contracts across our network, which allowed for a standardization of vendors, and the opportunity to obtain excellent pricing.” It also led to Supply Chain and IT meeting HonorHealth’s stretch savings goal for 2018. But in order to meet those goals, changes were needed in the way the organization’s departments worked together. “Historically, our IT contracting was decentralized within functional siloes where ensuring all contracts received proper review and scrutiny presented a challenge,” Scott said.

Category versus contract management At HonorHealth, Supply Chain Strategic Sourcing & Engagement (SS&E) manages the day-to-day supplies and services contracting for the organization. The collaboration between the

Jordan Scott

September 2020

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Supply Chain and IT departments initially surfaced as request for assistance with IT contracts. Through standardization of the process, strategic sourcing proposed creating an IT Value Analysis Team (VAT) to align Supply Chain sourcing opportunities with the technology forecast. An early success with Print Management that improved price points and service levels gained inertia for establishing a presence for IT Category Management within Supply Chain, Scott said. The organization soon realized it could foster better outcomes by taking this tactical approach to a strategic one. In order to better steward its resources, HonorHealth’s Supply Chain Shared Services department adopted the methodology of category management versus contract management, which meant evaluating contract categories from a holistic approach versus individual point-in-time reviews. “This shifted our department’s focus from attempting to review 3,000+ contracts annually, to 300 categories, where we can better identify key strategic opportunities,” said Scott. Scott was in a unique position to help with the collaboration. In his previous role at HonorHealth, he worked in IT as an operations coordinator where he managed the budget, tracked termination dates, and developed project plans. The IT operations coordinator role provided insight into HonorHealth’s organizational technology plan, application schedule, and value of formal customer requirements gathering, Scott said. “This experience and perspective translated well into a category management role within Supply Chain Shared Services where I needed to engage stakeholders, anticipate strategic questions, and map a complete implementation plan.” Traditionally, IT led their own initiatives, built the vendor relationships and negotiated pricing. Once their action items were completed, the contracts were passed onto Supply Chain to manage and advance through the legal review process, Scott said. Through the new collaboration, Supply Chain was now part of the whole initiative from inception of the project through the implementation. “The value received from this collaboration includes alignment of organizational strategies, refined processes and controlling costs more effectively.” Three key items were needed to make the collaboration work, Scott said: Trust, alignment of goals, and senior leadership support from both IT and Supply Chain. “Bringing together a new team required the collaboration and solution-focused approach to ensure the alignment of goals were unified, without sacrificing

organizational excellence,” he said. “Searching for cost saving opportunities required close communication between the end users, stakeholders and the category administrators. We were also patient with the process and allowed for organic integration, which was more collaborative than the top down mandate.” As IT integration became more of a focus throughout the organization, Scott said he has seen increased satisfaction with Supply Chain Shared Services by the clinical departments. “A big part of this is due to Supply Chain being able to proactively identify contracts with IT implications and proactively collaborating in the early stages of the process,” he said. “This has allowed for a more streamlined process, increased leadership visibility, reduction of time executing and implementing critical projects.”

In order to better steward its resources, HonorHealth’s Supply Chain Shared Services department adopted the methodology of category management versus contract management, which meant evaluating contract categories from a holistic approach versus individual point-in-time reviews. On the horizon HonorHealth will be opening its sixth hospital, Sonoran Crossing Medical Center, in September 2020. Scott said Supply Chain has partnered with the organization’s Enterprise Project Management Office to ensure current contracts include the new location and that services are fully functional on opening day. “Working with various departments throughout this process has provided new insights on the challenges and resources required for successful hospital operations,” he said. “Striving to be a future leader in healthcare, this project has allowed me the opportunity to learn new strategies and gain a more thorough understanding of all service lines throughout the hospital and dependency required from IT to thrive.” www.repertoiremag.com

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September 2020

Brace Yourselves Distributors, manufacturers and supply chain teams across the country were hard at work preparing for the upcoming respiratory season.

In 2020, there will be no rest for the weary. At least not in the healthcare supply

chain. As summer turned to fall, the nationâ&#x20AC;&#x2122;s med/surg community was hard at work making preparations for known demand and the unknown possibility of COVID-19 surges. Repertoire spoke to several stakeholders about the preparations and expectations of what promises to be an unprecedented fall season.

September 2020

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Preparing for Fall Industry Prepared for COVID-19 Vaccine Alarms were raised this spring and summer about potential shortages of vaccine-related products. Despite the uncertainty, industry experts expressed confidence the country would avoid situations such as the PPE shortages experienced earlier in the year. The race to develop a COVID-19 vaccine has been in the

Feds take action

public eye since spring. The race to provide enough needles, syringes and glass vials to administer it has been somewhat lower key. Still, it hasn’t been without nervous moments. For example, in early May, Rick Bright, former deputy assistant secretary for preparedness and response and director of the Biomedical Advanced Research and Development Authority (BARDA), warned that the nation’s stockpile of needles and syringes was only 2% of the required amount. (In addition to anticipating a twoshot vaccine, Bright’s calculations included about 180 million more syringes for an increase in requests for flu shot, reported USA Today.)

The federal government has taken an active role, contracting for 820 million syringes, including 420 million by the end of 2020 and the rest in 2021, reported USA Today. ʯ In May, BARDA – part of the Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response – awarded contracts for needles and syringes for approximately $110 million to Retractable Technologies (Little Elm, Texas) and Marathon Medical (Aurora, Colorado) for 320 million needles and syringes, and to Franklin Lakes, New Jersey-based Becton Dickinson for approximately $11 million for 50 million units of needles and syringes.

ʯ Also in May, the Department of Defense and HHS announced a $138 million contract with ApiJect Systems America for U.S.-based manufacturing capacity that could produce approximately 100 million pre-filled syringes using the company’s “blow-fill-seal” technology in 2020, and more than 500 million through 2021.

ʯ In mid-July, Smiths Medical announced a partnership with BARDA and the Department of Defense to expand capacity at its facility in Keene, New Hampshire, for production of integrated hypodermic needle and syringe products to support COVID-19 vaccination. The federal government will have priority access to this expanded capacity for vaccination efforts dedicated to COVID-19, flu vaccines, and future pandemics. Questions about the vaccine remain. For example, when will it be available? How quickly will it be rolled out? Will it be injected, or taken orally or nasally? Will it be delivered in pre-filled syringes? Will one injection be enough to achieve immunization, or will two injections be needed? How many Americans will actually get vaccinated? 16

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ʯ In July, BD announced a partnership with BARDA to develop new manufacturing lines for injection devices that would provide priority access to the U.S. government for hundreds of millions of syringes and needles to support current and future pandemic

Prepare for flu season 2020. PPrreeppaarree ffoorr fflluu sseeaassoonn 22002200.. Select BD needles and syringes. Select PSelect repareBD foneedles rneedles flu seasand on 2syringes. 020. BD and syringes. Select BD needles and syringes.

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The BD Eclipse™ Needle provides streamlined and effective injection ™ Needle The BDand Eclipse provides safety allows for shielding of the streamlined and effective injection needle immediately ™ Needleafter The BDtip Eclipse provides safety andwith allows for shielding of the injection, a single finger stroke. streamlined and effective injection needle tip immediately after safety and allows for shielding of the injection, with a single finger stroke. needle immediately ™ Needle after The BDtip Eclipse provides ™ a single BD Eclipse BDinjection Cat # injection, with finger stroke. streamlined and effective safety and for shielding of the 25 x 5/8allows in. 305759 ™ BDGEclipse BD Cat # needle tip immediately after 25 G x 1 in. 305761 ™ a single finger BDGEclipse BD Cat # injection, with stroke. 25 x 5/8 in. 305759 25 G x 1 1/2 in. 25 G x 1 in. 25 G G xx 15/8 in. in. 23 25 G x 1 1/2 in. 22 25 G G xx 11 in. in. BDGEclipse 23 x 1 in. ™ 22 25 G G xx 11 1/2 1/2 in. in. 22 GGxx15/8 in. in. 25 21 G x 1 in. 23 G x 1 in. 22 GGxx111/2 in. 25G in. in. 21 22 G xx 11 1/2 in. 21 G x 1 in. 25 G Syringe 1/2 in. in. 122 mL G xx 11 1/2 21 GGxxG11x1/2 in. w/ 25 5/8 23 in. 21 G x 1 in. in. 122 3 mL G Syringe in. in. 21 G xx 11 1/2 w/ 25 G x 5/8 in. G xSyringe 1 1/2 in. 122mL 3 mL Syringe 21 G x 1 w/ 25 G 5/8in. in. w/ 25 G xxin. 5/8 1 in. G xSyringe 1 1/2 in. 321mL 3 mL Syringe w/ 25 Syringe G xx 15/8 1 mL w/ 25 G in. in. 23 25Syringe G x 5/8 in. 3w/mL 3 mL Syringe w/ 25 Syringe G xx 11 in. in. 3 mL w/ 23 G 22 x 1 1/2 in. 25Syringe G x 5/8 in. 3w/mL 3 mL Syringe w/ 23 G x 1 in. in. in. 3 mL Syringe w/ 22 G 21 xx 11 1/2 w/ 25 G x 1 3 mL Syringe 3 mL Syringein. w/ 22 Syringe G xx 11 1 1/2 1/2in. in. 3 mL w/ 21 G in. w/ 23 G x 1 in. 3 mL Syringe 3 mL Syringe w/ 21 Syringe in. in. 3 mL w/ 21 GGxx111/2 22Syringe G x 1 1/2 in. 3w/mL w/ 21 Syringe G x 1 1/2 in. 3 mL w/ 21 G x 1 in.

305767 305761 305759 305762 305767 305768 305761 BD Cat # 305762 305763 305767 305768 305759 305764 305762 305763 305761 305765 305768 305764 305767 305763 305780 305765 305762 305764 305768 305780 305765 305781 305763 305780 305781 305764 305787

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Preparing for Fall vaccination efforts. BARDA agreed to invest an estimated $42 million into a $70 million capital project to further expand BD’s operations and manufacturing capacity in Nebraska. The new capacity was expected to be online within 12 months. Later that month, BD signed an agreement with BARDA for 140 million injection devices for the U.S. market. “We’ve been very clear that these large pandemic orders will not affect BD’s ability to fulfill existing customer requirements for needles and syringes, including the annual flu vaccination and childhood immunization campaigns,” BD spokesperson Troy Kirkpatrick told Repertoire in mid-July. “We have capacity to manufacture hundreds of millions of syringes between now and January, but if governments wait too long, there will not be enough manufacturing capacity across the global industry to make billions of devices in a month or two. “A vaccination campaign the size and scope ‘A vaccination of an entire country/ world isn’t something campaign the that happens in a month,” size and scope he added. “It will be the of an entire better part of a year to get everyone inoculated, country/world so even if the new lines isn’t something don’t come online for 12 that happens months, there could still in a month.’ be a significant need for devices at that time.”

Avoiding panic buying Terry Altshuler, portfolio executive for Vizient Inc., told Repertoire that needle-and-syringe suppliers indicate they have a surplus of product due to the decline of non-essential procedures that accompanied COVID-19. “In addition, suppliers are factoring in the possibility of a vaccine being available and making the necessary preparations,” he said. “While they are allocating product to an extent, the intent is to avoid ‘panic buying’ and ensure that facilities throughout the country are able to obtain product.” Mittal Sutaria, Vizient’s vice president, contracting and program services for pharmacy, said that as of midJuly, Vizient was not aware of any members attempting to stockpile needles and syringes. “After the government 18

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began placing orders for needles and syringes in May in anticipation of a vaccine for COVID-19, most manufacturers and distributors put their products on protective allocation to prevent anticipatory purchasing by providers and to help ensure that available product is distributed as evenly as possible across all healthcare settings,” he said. “From a vaccine perspective, there are still too many unknowns when it comes to considerations for creating a stockpile. The allocation of vaccine will involve many stakeholders, including manufacturers, distributors, hospitals, government and public health entities.”

Right measures and steps Chaun Powell, group vice president of strategic supplier engagement at Premier Inc., said that Premier members anticipate having enough needles and syringes to get through flu season and COVID-19 vaccines. “Lead indicators show that providers and supply chain stakeholders are taking the right measures and steps to be prepared,” he said. “Over the next 18 months, we, as a nation, will have contracted to create more than 870 million syringes above normal production, which exceeds 5 billion syringes for the acute domestic healthcare industry alone. In addition, the private sector is also ramping up its production output. Assuming there are no unforeseen external variables, we anticipate having enough syringes.” The situation with needles and syringes differs from that faced with N95s earlier in the year, he added. “With N95s, we, as a country, went from a national consumption rate (specific to acute healthcare) of approximately 25 million masks annually to over 300 million. The twelve-fold increase was unsustainable. With syringes, our baseline is 5 billion consumed annually in the acute space. Adding another 800+ million syringes indicates an approximate 20% increase, but it is no comparison to the twelve-fold impact we saw with masks.” What’s more, the U.S. healthcare supply chain has had the time and foresight to increase production and inventories of needles and syringes, he said. Premier members express confidence that their physician practices will have enough needles and syringes to meet upcoming demand, added Powell. “In our June survey of acute care members, we asked our members how adequate they felt their inventory of vaccines was in physician offices. Eighty-three percent said they had an adequate supply, and in fact, a small number (2%) noted they were overstocked due to the decrease in other procedures.”

Preparing for Fall

Sekisui: ‘Robust’ respiratory season ahead Editor’s note: Jonathan Overbey, corporate alliances and channel management, Sekisui Diagnostics, provided Repertoire

with insights into how the company is preparing for the upcoming respiratory season.

Repertoire: How are you preparing for the upcoming flu season amid COVID-19? Overbey: We are ramping up production of all of our flu testing options in preparation for a robust respiratory season as we continue to monitor the COVID-19 pandemic. We are also prepping our reps with proper PPE, supplies and guidance so they are protected when they get back out in the field. Repertoire: What kinds of challenges does this upcoming season present? Overbey: The pandemic is causing many issues but one in particular is the overall stress on the healthcare supply chain. The current situation could cause more testing for all respiratory tests including flu, strep, and RSV which could be very taxing on manufacturers trying to keep up with demand. On the other hand if there is a second wave which triggers another round of shelter-in-place orders, we could see a very mild to limited season which 20

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will add to the complexity of predicting and planning for this Flu Season. Repertoire: What are you hearing from providers in their preparations? Overbey: PPE as well as infection control is top of mind and rightly so. With regards to testing it is all about availability of products to test patients. All manufacturers are working diligently to increase production to meet the overwhelming demand. It’s going to take time to ramp up sufficiently to meet the global need. Repertoire: Besides PPE, what product categories, or even raw materials, will the supply chain need to monitor for any possible disruptions? Overbey: Swabs are one of the key raw materials for diagnostic tests, and the demand for testing is outstripping the supply. The lack of swabs will continue to limit the amount of tests available.

BD: ‘Dramatically’ scaled up production Editor’s note: Jim Berdela, channel development and marketing vice president sales distribution for Becton Dickinson, shared his thoughts on BD’s preparation and expectations for the upcoming respiratory season. Repertoire: How are you preparing for the upcoming flu season amid COVID-19? Jim Berdela: We have dramatically scaled our production for test kits for our BD Veritor™ Plus Analyzers and test kits. By September, we will be able to produce 8,000 analyzers per month and 2 million test kits for influenza A/B and COVID-19 per week, roughly four times our production capacity during the 2019-2020 flu season.

Repertoire: What kinds of challenges does this upcoming season present? Berdela: We anticipate unprecedented demand for the BD Veritor™ product line. We expect patients will be vigilant if they develop symptoms of respiratory infections like influenza and COVID-19 and seek testing.

Repertoire: What are you hearing from providers (e.g. HCPs) in their preparations? Berdela: HCPs want to be prepared to meet the testing needs of their patients. They find it compelling to be able to offer their patients answers while the patient is still

Repertoire: Besides PPE, what product categories, or even raw materials, will the supply chain need to monitor for any possible disruptions? Berdela: All diagnostic tests for COVID-19, as well as sample collection media and swabs will be in high demand.

on-site, without having to wait several days for a test to be sent to a reference lab for processing.

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September 2020

Preparing for Fall Understanding the Differences What are the differences between Influenza (Flu) and COVID-19? The CDC explains.

Influenza (Flu) and COVID-19 are both contagious re-

spiratory illnesses, but they are caused by different viruses, according to the CDC. “COVID-19 is caused by infection with a new coronavirus (called SARS-CoV-2) and flu is caused by infection with influenza viruses,” the CDC said on its website. “Because some of the symptoms of flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone, and testing may be needed to help confirm a diagnosis. Flu and COVID-19 share many characteristics, but there are some key differences between the two. While more is learned every day, there is still a lot that is unknown about COVID-19 and the virus that causes it. The following table compares COVID-19 and flu, given the best available information to date.

Signs and symptoms Similarities Both COVID-19 and flu can have varying degrees of signs and symptoms, ranging from no symptoms (asymptomatic) to severe symptoms. Common symptoms of COVID-19 and flu include: ʯ Fever or feeling feverish/chills ʯ Cough ʯ Shortness of breath or difficulty breathing ʯ Fatigue (tiredness) ʯ Sore throat ʯ Runny or stuffy nose ʯ Muscle pain or body aches ʯ Headache ʯ Some people may have vomiting and diarrhea, though this is more common in children than adults Differences Other signs and symptoms of COVID-19 may include change in or loss of taste or smell. (More symptoms may be added following this issue.) 22

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How long symptoms appear after exposure and infection Similarities For both COVID-19 and flu, 1 or more days can pass between a person becoming infected and when he or she starts to experience illness symptoms. Differences If a person has COVID-19, it could take them longer to develop symptoms than if they had flu. COVID-19 ʯ Typically, a person develops symptoms 5 days after being infected, but symptoms can appear as early as 2 days after infection or as late as 14 days after infection, and the time range can vary. Flu

ʯ Typically, a person develops symptoms anywhere from 1 to 4 days after infection.

How long someone can spread the virus Similarities For both COVID-19 and flu, it’s possible to spread the virus for at least 1 day before experiencing any symptoms. Differences If a person has COVID-19, they may be contagious for a longer period of time than if they had flu. COVID-19 ʯ How long someone can spread the virus is still under investigation. It’s possible for people to spread the virus for about 2 days before experiencing signs or symptoms and remain contagious for at least 10 days after signs or symptoms first appeared. ʯ If someone is asymptomatic or their symptoms go away, it’s possible to remain contagious for at least 10 days after testing positive for COVID-19.

Flu

ʯ Older adults ʯ People with certain underlying medical conditions ʯ Pregnant people

ʯ Most people are contagious for about 1 day before they show symptoms. Older children and adults with flu appear to be most contagious during the initial 3-4 days of their illness but many remain contagious for about 7 days. Infants and people with weakened immune systems can be contagious for even longer.

How it spreads Similarities ʯ Both COVID-19 and flu can spread from personto-person, between people who are in close contact with one another (within about 6 feet). ʯ Both are spread mainly by droplets made when people with the illness (COVID-19 or flu) cough, sneeze, or talk. ʯ These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. ʯ It may be possible that a person can get infected by physical human contact (e.g. shaking hands) or by touching a surface or object that has virus on it and then touching his or her own mouth, nose, or possibly their eyes. ʯ Both flu virus and SARS-CoV-2 may be spread to others by people before they begin showing symptoms, with very mild symptoms or who never developed symptoms (asymptomatic). Differences While COVID-19 and flu viruses are thought to spread in similar ways, COVID-19 is more contagious among certain populations and age groups than flu. Also, COVID19 has been observed to have more superspreading events than flu. This means the virus that causes COVID-19 can quickly and easily spread to a lot of people and result in continuous spreading among people as time progresses.

People at high-risk for severe illness Similarities Both COVID-19 and flu illness can result in severe illness and complications. Those at highest risk include:

Differences COVID-19 ʯ School-aged children infected with COVID-19 are at higher risk of Multisystem Inflammatory Syndrome in Children (MIS-C), a rare but severe complication of COVID-19. Flu

ʯ Young children*

* The risk of complications for healthy children is higher for flu compared to COVID-19. However, infants and children with underlying medical conditions are at increased risk for both flu and COVID-19.

Complications Similarities Both COVID-19 and flu can result in complications, including: ʯ Pneumonia ʯ Respiratory failure ʯ Acute respiratory distress syndrome (i.e. fluid in lungs) ʯ Sepsis ʯ Cardiac injury (e.g. heart attacks and stroke) ʯ Multiple-organ failure (respiratory failure, kidney failure, shock) ʯ Worsening of chronic medical conditions (involving the lungs, heart, nervous system or diabetes) ʯ Inflammation of the heart, brain or muscle tissues ʯ Secondary bacterial infections (i.e. infections that occur in people who have already been infected with flu or COVID-19) Differences Additional complications associated with COVID-19 can include: ʯ Blood clots in the veins and arteries of the lungs, heart, legs or brain Multisystem Inflammatory Syndrome in Children (MIS-C)

Source: CDC website, www.cdc.gov/flu/symptoms/flu-vs-covid19.htm#table www.repertoiremag.com

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Preparing for Fall

Building Resiliency in the Supply Chain AHRMM Director of Supply Chain: America’s supply chain teams are working constantly to meet today’s challenges Heading into the upcoming respiratory season, there

remain a number of challenges for hospital and health system supply chain teams, said Mike Schiller, AHRMM director of supply chain. “First and foremost personal protective equipment (PPE) has been, and continues to be, strained since this pandemic began,” he said. “Worldwide demand for PPE, which is unlike anything we’ve ever experienced, and the recent increase in patient cases

stocks of critical pharmaceutical products including sedatives, neuromuscular and vasopressors in preparation for an expected surge this fall in COVID cases. Finally, with the pending availability of a vaccine, Schiller said supplies that support vaccinations must be front of mind including alcohol wipes, syringes and basic PPE to health care workers administering the vaccine.

Key areas

Contracting will change with some considering moving to multisource vs. sole source contracts, and opportunities to continue, or to strengthen sourcing relationships with local or regional companies that have been established over the past few months. will put more stress on an already overtaxed and fragile health care supply chain.” To meet current demand, hospitals continue to turn to non-traditional or novel manufacturers and suppliers to bridge their current supply needs and to increase their emergency stockpiles. Testing requirements and the supplies necessary to support testing is another area of focus and remains a challenge – inside and outside of the health care environment. Hospitals are building their safety 24

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Mike Schiller

While it’s early, there are a number of key areas supply chain professionals are focusing to build resiliency into their supply chains, Schiller said. Increasing on-hand inventory levels and relaxing Just-In-Time inventory principles. Contracting will change with some considering moving to multisource vs. sole source contracts, and opportunities to continue, or to strengthen sourcing relationships with local or regional companies that have been established over the past few months. Longer-term objectives include the adoption and utilization of data standards, including the Unique Device Identifier (UDI); needed transparency, inventory availability and utilization data upstream and downstream within the health care supply chain; improved/robust analytics capabilities. “Given all of these challenges, America’s hospitals and health systems are working constantly to meet the challenges of the COVID-19 pandemic, to protect our front line heroes, caregivers and patients,” Schiller said.

Preparing for Fall

Planning for Fall How one leading health system was mapping out its supply chain strategy for the expected flu/COVID-19 season in the fall. To say that requirements for PPE on-hand for health-

care providers has varied by location would be an understatement. Generally, it’s been managed at the state level, said Brad Alexander, vice president of business analytics and decision support resource engineering hospitality group, Providence St. Joseph Health. “The different markets and different states have different requirements around what we have to keep on hand depending on the phase of reopening that we’re in and the extent to which we are opening up our hospitals for elective procedures,” said Alexander. Which makes it tricky for healthcare providers with facilities in several states and markets. For instance, Providence’s organizations include 51 acute care facilities spread across seven states and markets from Alaska to Texas. In each market they must coordinate with state and local officials on PPE supplies needed is no easy task. Plus, the situation and requirements have been fluid. In Mid-June in Washington, providers needed seven to 10 days of PPE supplies on hand, but in urban settings in the Oregon market that number was much higher. California was like Washington in PPE requirements, but at press 26

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time the state was considering legislation that may have required hospitals to have on hand six months of supplies based on normal usage patterns. Figuring out how much PPE to have on hand was just one piece of the puzzle. Another was where to put all those supplies. “It’s a huge challenge,” said Alexander. Fortunately, Providence has been able to keep adequate stock on hand in its own facilities and maintain transparency with the state and local agencies around that. Alexander said the supply chain team built and deployed new tools in order to be able to track those inventories more dynamically and have “really good visibility on what we’ve got on hand at any given moment.” Providence also maintained space for its own inventory in the distribution centers of its distribution partner. “It’s referred to as the 3PL, but it’s basically just a space in their warehouses and their distribution centers where we own the inventory, we can pull on it as needed; as opposed to distributor-owned inventory that’s subject to their allocation and all their other customer demands. So, we can store and stockpile there instead of building out warehouse space in the hospitals or elsewhere offsite.”

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Preparing for Fall Alexander said that arrangement provides an outlet valve to maintain higher inventory levels. “Because when you look at some of these PPE categories, things like gowns, they’re incredibly bulky,” Alexander said. “Even 10 days of supply in crisis times for something like isolation gowns ends up taking huge amounts of space.”

The second part of preparation involves maintaining very tightly controlled inventory management practices. The supply chain team wants good transparency around critical supplies on hand. Through its current infrastructure, Providence can rebalance inventories dynamically across its broader network of hospitals. For instance, a hospital in the Seattle market may have lower inventory levels, but a hub location at one of the larger Seattle hospitals has more surge capacity to draw from, along with additional bulk stock at the distribution centers. “In this way, we can rapidly respond to the crisis as it evolves across our network of facilities.”

Modeling the upcoming season Alexander said Providence was using an effective epidemiology modeling capability to map out as best they could the upcoming weeks and months. The organization’s leader of clinical analytics, Ari Robicsek, chief medical analytics

officer at Providence St. Joseph Health, runs the group and function. He has partnered with external think tanks and other academic medical centers. “He is constantly going back and forth with other experts about their disease modeling and projections,” said Alexander. “And so, we partner with them and we build off of their modeling.” But even as effective as their work is, it’s hard to tell what the fall is going to look like, Alexander said. “We can kind of predict out ahead of us a couple of weeks or as much as maybe a month or so, but getting beyond that, you’re really starting to guess a little bit. With the onset of flu season in the fall, that’s where it becomes a lot harder to tell what’s going to happen.” Providence has made infection prevention a focus, with an open dialogue around each protocol and what the supply chain can handle. “We’re working to try as best we can to accumulate 60 to 90 days of supply, given our use rates, for a possible surge associated with flu season, and maintain those in our hub sites and at our central distribution center. And then we want to make sure that we are able to effectively pull on those inventories, rebalance across our sites as we need to.” The second part of preparation involves maintaining very tightly controlled inventory management practices. The supply chain team wants good transparency around critical supplies on hand. “The final part is partnering with our sourcing organization so that they are managing more flexible supply channels than we’ve had in the past, where we’ve got the ability to pull on greater quantities as we need to,” said Alexander. “That’s been a big challenge given all of the competing demands for PPE, but that team has done great work maintaining a little bit higher level of flexibility in those supply channels.”

About Providence Providence is a national, not-for-profit Catholic health system comprising a diverse family of organizations and driven by a belief that health is a human right. With 51 hospitals, 1,085 physician clinics, senior services, supportive housing and many other health and educational services, the health system and its partners employ more than 120,000 caregivers serving communities across Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington, with system offices in Renton, Washington, and Irvine, California.

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TRENDS

Selling to a Stressed-Out World A patient with diabetes frets because their out-of-pocket cost for insulin is $250. The doctor empathizes with her,

but realizes there’s little they can do to help. Physicians on average spend more time on their EMR than on patient contact, and one or two more hours of data input at home every night, studies show. How do physicians – who only want to connect with their patients – deal with that?

COVID-19 strikes, staff are laid off, and those remaining worry about contracting the virus or carrying it home. Meanwhile, physician-owners worry about keeping their practices and livelihoods alive. Now, you’re the sales rep, calling on that office. How do you maintain a productive relationship with them? 30

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‘Moral injury’ In 2019, for the first time since 2011, the physician burnout rate dropped below 50% among doctors in the United States, according to a triennial study conducted by researchers from the American Medical Association, the Mayo Clinic and Stanford University School of Medicine.

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TRENDS “Growing national efforts to address physician burnout are on the right track, but more work is needed to achieve meaningful change,” said then-AMA President Barbara L. McAneny, M.D. “Addressing the crisis requires continued investment from the health system in a comprehensive strategy that targets barriers to efficiently providing patients with high-quality care as the primary driver of physician burnout.” Jeff Panzer, M.D., MS, vice president for care transformation at Heartland Health Centers, a network of federally qualified health centers in Chicago, prefers the term “moral injury” to “burnout.” “The term ‘burnout’ could imply there’s something inherently wrong with the individual provider or care team member,” he said. “Moral injury,” on the other hand, points to the systems

factors that are the reason for burnout. “It’s the idea that you know what you need to do to help people, but you’re not able to.” Many people point to electronic medical records systems as a contributor to burnout. “EMRs have made things more complicated,” said Panzer. With a master’s degree in quality, he believes in the value of measurement and quality, neither of which can be accomplished without smart technology. But too often, administrators and regulators have settled on surrogate measures for quality, and applied them in a rapid – and sometimes lazy – way, he said. “We went from no measurement or poor measurement, to this. We measure things that aren’t reliable indicators of quality, just because they’re measurable.”

‘Moral injury’ is the idea that you know what you need to do to help people, but you’re not able to.

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Simple Spirometry Better COPD care. Better quality of life for patients.

COPD is the third leading COPD is the third leading cause of death from cause of death from 1 disease in the US1 disease in the US

Cancer #2

COPD #3

are felt by many Americans.

in the US from COPD.2 The effects of this disease

In fact, one person dies every four minutes

Heart Disease #1

Total estimated cost of COPD in 20203

Americans are currently affected with COPD, yet close to half remain undiagnosed4

24 million

Of all direct COPD disease costs are oftentimes from preventable exacerbations5

75%

Percentage of decline in heart disease and cancer-related deaths since 1999. The rate of COPD-related deaths has not significantly changed3

$49 billion

COPD-related deaths each year in the US2

160,000

19%

a primary care facility, 2 leave with undiagnosed COPD.7

For every 20 patients that walk into a primary care facility, 2 leave with 7 into For everyundiagnosed 20 patients that walk COPD.

2 out of 20

Or less of patients ever receive spirometry testing8

30%

Spirometry testing is the most effective and common method for diagnosing COPD. In fact, it is the clinical standard for accurate and repeatable measurement of lung function. In fact, it is the clinical standard for accurate and repeatable measurement of lung function. But without spirometry, many primary care physicians are severely underdiagnosing But without spirometry, many primary care physicians are severely underdiagnosing and inadequately treating patients.6 and inadequately treating patients.6

Spirometry testing is the most effective and common method for diagnosing COPD.

Earlydetection detection of Early of COPD COPDisiskey. key. Are we we falling falling short? Are short?

36% 36% Of primary care physicians report the inability to incorporate spirometry Of primary care physicians into the patient flow10report the inability to incorporate spirometry into the patient flow10

47% 47%

Of primary care physicians report not having spirometry devices10 Of primary care physicians report not having spirometry devices10

Primary care physicians report not adhering to guidelines on spirometry 10 Primary care physicians report use more than 90% of the timenot adhering to guidelines on spirometry use more than 90% of the time10

3 out of 4 3 out of 4

and quality of life, and to reduce the frequency and impact of exacerbations.

Primary care physicians are in an ideal position to be able to detect COPD in its early 8,9 is stages and spirometry confirm the diagnosis. Primary careperform physicians are in anto ideal position to be able toManagement detect COPDofinCOPD its early largely out inspirometry primary care much can now be 8,9 done to improveofsymptoms Management COPD is stages carried and perform to and confirm the diagnosis. andcarried qualityout of life, and to care reduce frequency and ofimprove exacerbations. largely in primary andthe much can now beimpact done to symptoms

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11 https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_WMV.pdf

10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064423/

9 https://www.ncbi.nlm.nih.gov/pubmed/16236907

8 https://reference.medscape.com/medline/abstract/21513435

7 Calculated

6 https://www.sciencedirect.com/science/article/pii/S0002934315000029

5 http://rc.rcjournal.com/content/63/5/591

4 https://www.hopkinsmedicine.org/news/stories/november_copd_awareness_month.html

3 www.cdc.gov/copd

2 https://www.cdc.gov/dotw/copd/index.html

1 https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd#:~:text=COPD %20is%20the%20third%20leading,term%20disability%20and%20early%20death.

Sources:

Learn more at: midmark.com/COPDcare

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is working to improve the lives of people with COPD in every corner of the globe. The Midmark Digital Spirometer utilizes the GOLD standard11 for the diagnosis and management of COPD.

Clinical Standards

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TRENDS Fix the workplace, not the workers Christine Sinsky, M.D., vice president of professional satisfaction for the American Medical Association, said burnout is nothing new. But in the past 10 years, it has been more widely studied, understood and talked about, she said. The AMA has aggressively addressed the issue through initiatives such as its Practice Transformation program, Steps Forward™ and the Joy in Medicine™ recognition program. Studies show that physicians are highly resilient, that is, they adapt well to stress, she said. “The problem is the workplace and chaotic work environments, not individuals. The interventions that are most effective are those that work to improve leadership, address values alignment between leadership and the front line, institute a sense of fairness in the organization, increase teamwork, and decrease clinical burden.”

Traditionally, physicians have been captains of the ship. But in doing so, they end up being an island. An important driver of professional fulfillment and better patient outcomes is a sense of autonomy, she continued. In large, health-system-owned practices as well as smaller ones, that can be reinforced by pushing decisionmaking authority to those who are closest to the patients. It also calls for strong leaders, who can strategically delegate work and eliminate unnecessary tasks.

Part of a team? Administrators, consultants and others have tried to address burnout in predictable – but not always effective – ways, said Andy Swanson, vice president of industry insights, Medical Group Management Association. For example, they have tried rewarding physicians financially for meeting certain goals. “This has led to some positive financial results, but it also has led to problems insofar as longevity, engagement and clinical issues are concerned.” 34

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Another approach is emphasizing exercise, wellness and nutrition. “None of these things are bad,” he said. “But I would argue that they miss one of the most important facets of work, which is, ‘Do you feel part of a team?’” Physicians may not think to ask themselves that question. Traditionally, they have been captains of the ship. But in doing so, they end up being an island. The fee-for-service approach to medicine, which leads to wall-to-wall patients throughout the day, exacerbates the problem, said Swanson. “Production makes good business sense, but the work processes are skewed.” Electronic health records can contribute to stress when they are used more as financial tools than as clinical tools. Said Hari Prasad, CEO, Yosi Inc., “Any medical practice that accepts insurance and uses electronic medical record software requires a tremendous amount of administrative bandwidth to ensure documentation is completed in order to get reimbursed. So, in a way, most medical practices experience significant burnout due to a high need for managing documentation and insurance needs.” A solutions partner of Henry Schein, New York-based Yosi is a developer of patient intake and registration systems.

Sales reps: ‘Tread lightly’ Sales reps who walk into a practice that is showing signs of burnout should tread lightly, advised Kevin Barefoot, territory manager for MTMC, an outsourced sales organization. “End-users and clinicians tell me the shorter the emails and the shorter the sales pitches, the more success the sales rep will have.” Clinicians are looking for solutions for their problems, such as how to prevent infection issues or deal with long lead times on essential products, said Barefoot. “Bring supportive clinical evidence for products and solutions, and let them know about nearby health systems that are using them. Help them find products you may not even carry. Ask them how they are handling things right now in their practice. This will help you to connect on a personal level.” Said Swanson, physicians may not openly admit they feel burned out, but they will talk about the things that irk them, such as their EMR, paperwork, or simply being unable to spend quality time with patients. “Sales reps are experts on products and services that can improve customers’ clinical situations,” he said. “I would advise they tell their customer, ‘I understand you’re frustrated; is there some way we can help you with that today?’ Even if it’s an incremental solution, that physician knows there’s one more person helping the practice.”

Resources ʯ “Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being,” National Academies Press, 2019.

ʯ American Medical Associa-

tion: Joy in Medicine™ recognition program. Designed to guide organizations interested, engaged, and committed to improving physician satisfaction and reducing burnout.

ʯ American Medical

Association: Steps Forward™, https://edhub.ama-assn.org/

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steps-forward. More than 50 modules on topics including: practice transformation, burnout and well-being, EHR and technology, organizational culture, patient-physician experience, team-based care and workflow.

ʯ American Medical Asso-

ciation, “Caring for our caregivers during COVID19,” March 2020. Practical strategies for health system leadership to consider in support of their physicians and care teams during COVID-19.

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TRENDS

Diversifying the Supply Strategy When member needs outweighed current contracted supplies, Vizient approached one manufacturer about a unique way to quickly scale to meet demand.

How do you handle a demand increase of 10 times the normal amount? For healthcare suppliers and providers,

that scenario became a reality almost overnight. “In the pre-COVID industry environment, there was simply no way that the suppliers or providers could have adequately planned for this unprecedented and ongoing spike in demand for PPE,” said Margaret Steele, vice president, contract and program services for Vizient, Inc.

One example is the use of N95 respirators before and after COVID-19. Given the significant barrier protection these respirators provide, their use was limited to surgeries and other high-risk cases before COVID-19. This meant a minimal number of staff were using them 36

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on daily basis on a limited number of patients. “For the 3K+ hospitals we serve, this translated to an annual usage of ~10M/YR,” said Steele. “During COVID-19, the use of these respirators expanded through many more patient interactions and many more staff using them each day.

Early indications are that in the next 12 months we will challenges including finding the product, the cash outlay see purchase volumes of these same respirators potenfor that product, finding space to appropriately store it tially go beyond 1 billion.” and ensuring the inventory is turned regularly to keep the Gowns have seen similar levels of exponential surges products from expiring. in demand and Vizient has been working to increase sup“When the pandemic really hit hospitals, providers ply. One of the GPO’s initiatives involves an agreement looked to their distributors to find alternative resources with Encompass that Steele said will bring 19 million when supplies were scarce,” Steele said. “Some also AAMI level-3 disposable isolation gowns into the supply decided to go direct with vendors that were offering chain yet this year. products such as N95 masks which were in such high In March, Steele said her organization quickly recogdemand. To that end, many healthcare facilities were nized the rising need for AAMI level 3 isolation gowns and hurt by unsavory suppliers/brokers. However, I now the lack of supply to meet the growing demand. Vizient believe they understand that their GPO partner is in a met with Encompass executives to discuss the possibilbetter position to identify and vet alternative sources for ity of restarting some manufacturing lines in Mexico. An supplies for them. Vetting suppliers is difficult and time agreement was put into place enabling Vizient members consuming. This is where the GPOs really can play a role to have exclusive access to millions of these gowns during in providing necessary protections for their customers.” this pandemic. “As member needs increased, Encompass was able to quickly scale to meet the demand,” said Steele. “This is an example of how Vizient will find ways to contract short term with suppliers who can provide supplemental product during times when member demand outweighs the ability to meet demand by current contracted suppliers.” As a result of the supply challenges from the pandemic, Steele said many Vizient members have requested to diversify their current supply strategy to include those with U.S. or North American based – Margaret Steele, vice president, contract and program services for Vizient, Inc. manufacturing. “While many suppliers have or have committed to having manufacturing plants in North Healthcare providers have begun to work more America, we are evaluating the top PPE categories to be closely with other hospitals, some of which were comsure we address this imperative for our members,” she petitors for things like N95 respirators, isolation gowns said. “At Vizient, we want to offer more to members than and face shields. “We witnessed a lot of healthy collabojust additional supply options. We are also focused on ration between our members to help one another when improving supply chain resiliency for suppliers by offerthey could.” ing a two-sided marketplace. This new digital platform Steele said she suspects we might see a return to more will bring visibility to the availability, consumption and use of reusable products (i.e., gowns, masks, etc.). “This need for supplies.” certainly guarantees supply. However, facilities will have to Moving forward be certain they have the appropriate sterilization services Steele said the majority of Vizient’s members are looking in place. The initial inventory investment can be substanto have a minimum of 90 days of certain products on tial as well. We are hearing from many Vizient members hand moving forward. These products include facial prothat moving forward they will use a hybrid of disposable tection, isolation gowns, gloves, etc. This presents several and reusable gowns and caps.”

“ While many suppliers have or have committed to having manufacturing plants in North America, we are evaluating the top PPE categories to be sure we address this imperative for our members.”

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TRENDS

Combating COVID with Data The Collective and Augmented Intelligence Against COVID-19 (CAIAC) alliance An alliance of researchers across the country has formed to tackle complex data in an effort to better combat COVID-19.

The Future Society and Stanford Institute for Human-Centered Artificial Intelligence (HAI), with the support of UNESCO and the Patrick J. McGovern Foundation, announced the creation of the Collective and Augmented Intelligence Against COVID-19 (CAIAC) alliance. CAIAC will establish an advisory group which aims to welcome experts from international organizations, including UNESCO, UN Global Pulse and other UN entities.

CAIAC will structure the rapidly expanding collection of global health, social and economic data on the pandemic to enable the world's decision-makers to confidently take action. “By turning data into knowledge, CAIAC will help those at the forefront of the fight against COVD-19, including multilateral institutions, policymakers, healthcare leaders, and the scientific community,” a release said.

Scarcity of data Actionable COVID-19 data has been scarce because the virus is still novel, the CAIAC said. At the same time data is abundant, as it emerges quickly from many different sources with no trusted filter. Research institutions, think-tanks, and NGOs have hurried to add their analyses and models to the data being reported by countries. The result, however, is a mass of information and a shortage of insight. “To respond to this pressing global challenge, CAIAC is bringing together multiple data sources and expertise from a diverse group of global initiatives and building a dynamic and state-of-the-art decision-support tool that is comprehensive, authoritative, up-to-date, and ethical,” the release said. The initiative's founding members are partnering closely with private sector companies, including C3.ai, stability.ai, Element AI, Axis, GLG, and Planet on the technology that combines human and artificial intelligence to power this decision-making platform. Covington & Burling LLP is providing legal guidance for the initiative. The platform will be available to multilateral organizations, governments and global entities. CAIAC will also collaborate with technical, scientific, and civil society partners around the world to collect data on COVID-19, identify critical domains where structured information on the pandemic is needed most. 38

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CAIAC aims to create a Minimum Viable Product (MVP) focused on three initial use cases: ʯ Tracking and tracing of contagion chains via mobility data and artificial intelligence ʯ Identifying and addressing inaccurate information on COVID-19, ʯ Finding marginalized areas most affected by second and third order pandemic impacts to deploy the appropriate interventions needed. “CAIAC will enable the global community to better identify best practices and coordinate in the fight against COVID-19 by providing cross-country and cross-sector insights on all aspects of the pandemic,” the release said. “The key to sustainable results is multi-stakeholder collaboration on a common, unified, transparent knowledge base that documents and disseminates best practices. CAIAC hopes to accelerate solutions that will help the world navigate the current pandemic, while also building a foundation of knowledge to address future global challenges.” For more information, visit www.caiac19.org.

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their infection, according to the CDC, whose data shows the annual rate of reported acute hepatitis C infection tripled from 2009 to 2018. Often noted as a silent epidemic because of its low public profile, untreated HCV can lead to chronic liver issues and even be deadly. HCV is curable, so point-of-care screening for the virus is crucial to connecting patients to treatment and reducing community transmission.

For those affected by HIV and HCV, this means continuing to test those who need and want it, even throughout a pandemic, and linking them to care if the test is positive.

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distancing guidelines, mitigating potential exposure to COVID-19 for provider and patient.

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ʯ When utilized together, both tests form the OraQuick® rapid point-of-care solution. Providers can receive two highly-accurate results from one fingerstick in as little as 20 minutes with a simple CLIA-waived three-step process. This also allows providers to batch tests, enabling more people to get tested, reducing indirect costs and improving turnaround time. OraSure is a proponent of the democratization of testing and the importance of making reliable testing available to all, which provides people with powerful ownership over their own health information. Ultimately, all people deserve access to accurate diagnostics and treatment regardless of ZIP code or income level. For those affected by HIV and HCV, this means continuing to test those who need and want it, even throughout a pandemic, and linking them to care if the test is positive. Please head to orasure.com/smm to learn how OraSure can help you End the Epidemics with the OraQuick rapid point-of-care platform and see how OraSure can help partners continue testing programs despite the COVID-19 pandemic.

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SALES

5 Ways to Work Smarter, Not Harder in Healthcare Sales By Sandler Systems

If you’re a healthcare sales representative, the future looks bright. While times are admittedly still tough and

different in ways we never expected, your customers and prospects need you and your products and services now more than ever. But like many salespeople in times that have been changed by factors beyond our control, you might be sabotaging yourself without even realizing it.

With all the change, it’s a fact that your sales approach must also change. Customers are looking for guidance and direction to navigate these times. Your value comes more from being a trusted advisor than from trying to win people over by lower prices. To service existing customers and take advantage of new opportunities, you need to apply strategy and methodology to your sales process on a consistent basis. You’ll find you’re able to do a lot more business in a lot less time if you take a fresh look at the old adage of “work smarter, not harder” – and if you follow our tips for avoiding these common traps in your industry: 42

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No. 1: Stop working from an “RFP” mentality Replying to large health systems’ quotes or requests for proposals is a big deal in your business. Everybody feels as if he or she has to price low, and that the lowest price is the one that wins. But guess what? It’s not all about price, even when the customer says it is. The solution: Instead, work from a mentality of matching solutions to expressed pain, and the potential customer’s willingness to commit to fixing their challenges. Build relationships year-round, keep up to date on new practices and change within practices, and get a good understanding of what really motivates a potential customer.

That way, when the bidding and quoting begins, you have a relationship as your starting point, not just a price.

No. 2: Stop putting all of your eggs in one prospecting basket In the medical sales world, there are two types of prospects: We’ll call them “Prospect A” and “Prospect B.” Prospect A is a customer or practice with whom you’re already working. You call on them about both ongoing and new business. Prospect B is a doctor or a practice or a lab with whom you’re not already working, and on whom you call or visit to talk about new opportunities. Unfortunately, 90% of the “prospecting” done is focused on Prospect A. The solution: Develop a proactive plan for prospecting, and put a major focus on it. Don’t be overly reliant on Prospect A, the ones giving you existing business. Provide great account management, yes, but focus on expanding your client base by targeting Prospect B and making the

effort to go after brand new business. Plant seeds for success, don’t just harvest what’s already in the ground.

No. 3: Stop calling on people who aren’t the ultimate decision makers If you’re like many sales reps, you may not be calling on the right person, who is typically the doctor, the practice owner/manager, or the health system or supply chain manager. How do you develop relationships with these ultimate decision makers for selling that’s more targeted and effective? The solution: Healthcare sales reps typically do a good job of learning how to make peace with gatekeepers or the front office staff. The trouble is, you eventually want to meet the ultimate decision makers, right? You want time with the practice owners, the doctors with delivery issues, the practice managers with distribution and supply challenges. Whatever the competition is doing – stop doing that. Use some pattern interrupt techniques so that

SALES you don’t sound like every other rep in the waiting room trying to get into the back office. “I knew what I was supposed to do with a potential practice customer – build trust, ask more questions than I answered, get them to tell me what would make them commit to being my customer – but I didn’t have a strategy. I just kind of floundered and stuttered my way through giving up all my leverage. Sandler taught me a process to do it the right way. I use the Certification badge in my email and profiles, and my employer paid for the training.” – Sandler Training medical sales rep client

With all the change, it’s a fact that your sales approach must also change. Customers are looking for guidance and direction to navigate these times. Your value comes more from being a trusted advisor than from trying to win people over by lower prices. No. 4: Stop being guided by your need for approval If you’re more concerned about making your prospect like you than about asking the tough questions, you’ll be at a huge disadvantage from the start. This is a universal problem for all sales representatives. The solution: First, apply the classic and powerful Sandler principle of learning to separate your “I” (who you are as an Individual) from your “R” (who you are in your job Role). Second, rely on another basic Sandler principle: get the Up-Front Contract. If you’re quoting a prospect consistently and getting relatively few orders, ask why. The Up-Front Contract enables you to set expectations on the front end of a relationship or conversation about what will happen and sets the tone for mutual respect. ®

No. 5: Stop letting your prospect control the sales process Too many sales reps follow their prospect’s system and lose control of the real potential. They’re acting as unpaid consultants and then fighting their way back when it’s time to negotiate the actual deal. You have to choose – do you want to be treated like a vendor, or like a trusted advisor? The solution: There’s a classic Sandler Rule that says “Stop spilling your candy in the lobby.” That means stop giving free advice just to get a foot in the door. When you do, you’re falling into your prospect’s process and giving them control. Instead, develop a systematic process for selling, asking the right questions, uncovering your prospect’s challenges, issues and gaps, and closing the sale. That way, you take control of the process and you’ll be the go-to person with the supplies and equipment your prospects are looking for, the great service they want, and the answers they need. If you’re like all too many sales representatives in the healthcare field, you have a system for quoting, but not a system for selling. As customers become more sophisticated, buyers appear to more demanding and professional in their negotiations, and you run the risk of not keeping up. With clear core principles to guide you, you can adapt your process to meet an ever-changing landscape, stay sharp, and get better results.

About Sandler Training With over 250 local training centers around the globe, Sandler is the worldwide leader for sales, management, and customer service training. We help individuals and teams from Fortune 500 companies to independent producers dramatically improve sales, while reducing operational and leadership friction. ©Sandler Systems, Inc. All rights reserved.

Sandler offers Sales Certification programs, which are often reimbursed by an employer as continuing education. Reach out to SalesTips@repertoiremag.com for details.

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REP CORNER

Healing Hearts How a medical diagnosis for one of her children was a springboard for Diane Feinauer into the medical community. By Graham Garrison

Within a span of 10 minutes Diane Feinauer and her husband Jonathan were given two life-changing bits of

news. The first was that a 20-week ultrasound revealed they would be having twins. But before they could really digest and celebrate that news, they received the second update from the ultrasound. One of the twins, Jacob, had a malformed heart and his stomach was on the wrong side of his body. “My world began to spin,” said Feinauer. “How was my precious baby going to survive with just half a heart?”

The ultrasound would change the Feinauers’ lives in many unexpected ways, leading to countless hospital and doctor visits, multiple surgeries, advocacy efforts – and ultimately into her role as a territory manager for MTMC.

A season of miracles Following the ultrasound, Feinauer was immediately given two amniocentesis tests, one for each twin, to find out if there was a genetic problem and if the twins were identical. Three weeks later, the results revealed that the twins were not identical and Jacob’s heart defect was not genetic.

When the twins were born, Jacob’s brother Jackson was 5 pounds, 6 ounces, while Jacob was 3 pounds, 12 ounces. Jacob had a BlalockTaussig (BT) shunt placed in his heart at three days old. “This was our first miracle,” said Feinauer. The family met with a pediatric cardiologist at 23 weeks. The cardiologist quickly diagnosed Jacob with double outlet right ventricle (DORV). He also noted that Jacob’s heart was backwards and that his 46

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REP CORNER great arteries, the primary arteries that carry blood away from the heart, were transposed. He then explained that he had the suspicion that in correlation to Jacob’s heart condition he also suffered from a form of heterotaxy syndrome, a condition in which the internal organs are abnormally arranged in the chest and abdomen. “It was very rare, but we wouldn’t know until he was born the extent of his medical concerns,” said Feinauer. “With that information, we waited for the arrival of our twins for another four months.”

across his abdomen and a single-ventricle heart defect. Because his left side didn’t form, he has no spleen, which puts him in a high-risk category for bacterial infections. Despite all of this, Jacob came out fighting and eating. Our next miracle.” At six months old, Jacob had a heart procedure, and due to his multiple systemic to pulmonary artery collateral networks, he almost died. A cardiologist performed an emergency coil occlusion the day after his heart surgery to save his life. “It was our only option left,” said Feinauer. “It somehow worked.” Another miracle. Jacob left the hospital almost three weeks later.

When Jacob entered the public school system at 5 years old, Feinauer noticed that Jacob’s elementary school didn’t have the resources to get an AED. Although a lot of the high schools in the Salt Lake City area had AEDs, there was nothing to protect kids that were born with congenital heart defects, she said. Feinauer was monitored very closely by a perinatologist and had to go into the hospital three times a week for non-stress tests. At 33 weeks, Jacob’s sac had no amniotic fluid left in it and Feinauer was rushed to the University of Utah for an emergency C-section to save Jacob. When the twins were born, Jacob’s brother Jackson was 5 pounds, 6 ounces, while Jacob was 3 pounds, 12 ounces. Jacob had a Blalock-Taussig (BT) shunt placed in his heart at three days old. “He was so little, I don’t know how he survived it, and we started our 24-hour care clock,” said Feinauer. “We had a newborn at home and a newborn in ICU for almost two months.” When they ran tests on Jacob after he was born, the heterotaxy syndrome was confirmed. “Essentially, the best way to describe Jacob’s version of the syndrome is to say that the right half of his body’s organs developed and then multiplied,” said Feinauer. “Jacob has two right lungs, two right kidneys, a transverse liver 48

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REP CORNER All told, Jacob has had three open heart surgeries. He is not a great candidate for a heart transplant due to his anatomy, but the Feinauers are hopeful that future medical advances will lead to a breakthrough. In the meantime, he is living a healthy and active life as a 16-year old athlete. Jacob was playing competitive soccer and varsity golf for his high school prior to COVID.

Feinauer has been involved in multiple areas of volunteer work to increase awareness of CHD.

Feinauer has been a multi-time sales award winner for MTMC.

He was also going to school. With the COVID pandemic, the Feinauers have been incredibly cautious, but Jacob has been healthy throughout. “We were extremely careful about his exposure to germs and slowly started exposing him around the age of five,” she said. “It’s similar to what we are dealing with right now. We went back to what we knew early on. The CDC recently came out with guidelines on children, and with Jacob being 16, is still classified as a child. Congenital Heart Disease is identified as an underlying condition for severe COVID-19, so essentially we are keeping him isolated.”

Getting involved When Jacob entered the public school system at 5 years old, Feinauer noticed that Jacob’s elementary school didn’t have the resources to get an AED. Although a lot of the 50

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high schools in the Salt Lake City area had AEDs, there was nothing to protect kids that were born with congenital heart defects, she said. Feinauer’s background was in marketing. When she realized the public school systems didn’t have funding for AEDs, she used her experience to launch Tender Heart Beats to lobby the legislature for funding, and also work with private donors to get AED placements throughout the valley in Salt Lake City and all Utah public schools. “The legislature did fund it,” she said. “So we were able to get AEDs throughout all of the schools in Utah.” Understanding that Jacob would be in and out of hospitals the rest of his life, Feinauer got involved in multiple areas of volunteer work to increase awareness of CHD and to work directly with families that are facing that diagnosis with their children. She has served several organizations in differing ways in the community. Organizations she helped found: ʯ Camp Hawkins: A camp for kids and siblings with CHD. ʯ Tender Heart Beats (THB): An organization dedicated to placing AEDs in all schools in Utah and raising money for CPR babies for Primary Children’s Hospital. ʯ Intermountain Healing Hearts (IHH): A support group for families of children and adults with CHD in Utah and the Intermountain West. Organizations she has served or represented: ʯ MOD SQUAD (Mothers for Organ Donation) Intermountain Transplant Team ʯ American Heart Association ʯ Primary Children’s Hospital Family to Family Volunteer Program

Entering medical sales As Jacob would eventually transition into adult care, Feinauer desired to work with healthcare providers in a different way to build relationships, and understand their priorities, outside of just being a patient. It led her to a medical field sales role with MTMC in the acute care segment. “It was a great fit because MTMC calls on every call point in the hospital,” she said. “I could have high-level meetings and understand how hospitals function, what directives and priorities they had, and line that information up with what was important to our family and Jacob’s care. I was eager to get into my hospital accounts, learn and understand.”

Feinauer said balancing her medical sales role with family life has been both rewarding and challenging. “I cover a large geography which means time away from the family and the kids,” she said. “But they were also at an age where they needed to start gaining some independence away from me.” However, her experience with her accounts has given the Feinauers access to resources that they wouldn’t otherwise know about. For example, Jacob occasionally requires infusions for electrolytes, or if he gets too dehydrated. By building relationships with infusion centers, the Feinauers have a better understanding of whether they need to take Jacob to the ER for a dehydration moment. “It’s been a real gift to be able to understand better the resources available,” she said. “Even though I’m spending precious time away from Jacob and the other children, I’m learning

Understanding that Jacob would be in and out of hospitals the rest of his life, Feinauer got involved in multiple areas of volunteer work to increase awareness of CHD and to work directly with families that are facing that diagnosis with their children.

Feinauer said balancing her medical sales role with family life has been both rewarding and challenging.

how to help him long term. At the same time, I’m educating myself to better understand what we will face in the next phase of his life.” In more than four years, Feinauer has been a multitime sales award winner for MTMC. She attributes her success to having a close connection to her accounts. “I’m looking to build genuine relationships with my accounts.” she said. “I want to understand their challenges and help them problem-solve. Understanding, at some point we could be patients in some of these accounts enables me to look at it from both perspectives – the perspective of the patient and the perspective of the hospital. I try to see the total landscape; what they’re up against, the financial challenges, and also understanding patient care is critically important to them.”

Some facts surrounding congenital heart defects (CHD): ʯ ʯ ʯ ʯ

CHDs affect nearly 1% of – or about 40,000 – births per year in the United States.

About 25% of babies with a CHD have a critical CHD. Infants with critical CHDs generally need surgery or other procedures in their first year of life. CHDs are a leading cause of birth defect-associated infant illness and death. Infant deaths due to CHDs often occur when the baby is less than 28 days old (sometimes called the neonatal period). In a study of neonatal deaths, 4.2% of all neonatal deaths were due to a CHD.

The prevalence (the number of babies born with heart defect compared to the total number of births) of some CHDs, especially mild types, is increasing, while the prevalence of other types has remained stable. The most common type of heart defect is a ventricular septal defect (VSD). About 97% of babies born with a non-critical CHD are expected to survive to one year of age. About 95% of babies born with a non-critical CHD are expected to survive to 18 years of age. Thus, the population of people with CHDs is growing.

Source: CDC website

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September 2020

SMART SELLING

Turn to ‘TED Talks’ for sales call inspiration during COVID-19 By Sharon Cohen, HIDA Communications Director

Just a few months ago, sales reps had a routine – making calls, setting up meetings, shaking hands, and sealing

deals. Today, many of these same sales reps are working from home – juggling the work day while caring for aging parents, coping with teenage drama, or maybe finding quiet time in a closet to take a call while the family preschooler watches “Finding Nemo” for the 157th time.

It’s a whole new world with sales field reps working remotely – using video, email, phone calls, and Zoom meetings. Many sales reps pre-pandemic already were connecting with customers via digital channels and have a base to build on. But where to take it from here during this unprecedented time?

The following are some tips from TED Talks that you can use Focus on one idea TED Talks are short, based on strategy and science. The tight timing gives the presenter – or in this case the sales rep – enough time to outline an idea, but short enough for a client to comprehend the content. Offer a core message… Your message should be contained in a short sentence – and be easy to remember and repeat. If your customers can’t retain your key message, did they really get it? …But make sure it’s not ‘cut and paste’ A strong sales presentation should have authenticity and customization.

Take a tip from TED Talks and its mantra, “Ideas worth spreading.” Most of us are familiar with TED Talks. They are popular for their insight and brevity. They invite the viewer to learn from a subject matter expert who spreads knowledge and shares experience. TED Chief Chris Anderson says connecting virtually begins with mindset. Anderson offers sales reps some advice in his 2016 book “TED Talks: The Official TED Guide To Public Speaking.” He advises presenters to think of a talk as being about an idea, not an issue: An issue-based talk leads with morality. An idea-based talk leads with curiosity. An issue exposes a problem. An idea proposes a solution. An issue says, ‘Isn’t this terrible?’ An idea says, “Isn’t this interesting?’ 52

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Make a connection You are a subject matter expert. That’s why you’re a success in your field. Ask yourself if you’re delivering the passion and conviction about your products and services to make that connection. Share your enthusiasm Don’t strive for perfection, just be prepared. Even if you’ve delivered this pitch multiple times before, keep your enthusiasm. If you seem bored, your clients will lose interest. (Tip: If you’re on that Zoom call – TED Talk guru Anderson says gestures matter too.) Good sales reps recognize that the power of research, due diligence, and perseverance leads to a strong client presentation. And remember that while you’re presenting on a sales call, make sure you’re also a good listener.

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Health news and notes Want to be healthier? Try limiting your TV time to 2 hours (or less) a day Now that social distancing, business closures, and limited building occupancy for some public locations, has become the norm, it can be difficult to be as active as we once were. You are probably staying home more and indulging in more sedentary activities, like watching TV or playing video games. More than ever, though, it is important to stay active and live a healthy lifestyle. One way we can do this, according to research, is to cut back on our time watching TV. Researchers say that cutting back to 2 hours a day may be a good way to prevent poor health.

TV, the researchers excluded those who had cancer and cardiovascular disease from their study. When they analyzed the data, the team found that those who had the lowest overall health risks were those who viewed TV for 2 hours or less per day. They estimated that 6% of all deaths and 8% of cardiovascular deaths were associated with TV-viewing time. Read more at www.healthline.com/health-news/ heres-why-you-may-want-to-limit-your-tv-time-to-2hours-a-day#Its-not-just-TV-watching-per-se,-though.

Body and mind The pandemic has been stressful for everyone. Fear and anxiety about a new disease and what could happen can be overwhelming and cause strong emotions in adults and children. Not to mention that social distancing and isolation can make you feel, well, isolated and lonely. While these actions are necessary to reduce the spread of COVID-19, coping with stress in a healthy way will make you and the people you care about, stronger. The CDC says that stress during an infectious disease outbreak can cause the following: ʯ Fear and worry about your own health and the health of your loved ones, your financial situation or job, or loss of support services you rely on. ʯ Changes in sleep or eating patterns. ʯ Difficulty sleeping or concentrating.

One study used data from people who were recruited between 2006 and 2010 to participate in the UK Biobank, a large, long-term study aimed at studying how genetics and environment impact the development of disease. In the study, the researchers looked at data regarding the lifestyle and demographics of 490,966 people between the ages of 37 and 73. The study participants were followed from 2006 to 2018, with their data being linked to national routine death and disease registries. To rule out the possibility that poor health was causing the participants to be more sedentary and watch more 54

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Mental health is an important part of overall health and wellbeing. It affects how we think, feel, and act. It also has an effect on how well we handle stress, relate to others, and make choices during an emergency. People with pre-existing mental health conditions or substance use disorders may be particularly vulnerable in an emergency. Mental health conditions affect a person’s thinking, feeling, mood or behavior in a way that influences their ability to relate to others and function each day. These conditions may be situational (short-term) or long-lasting (chronic). People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms. The CDC has compiled a long list of mental health resources and advice on its website at www.cdc.gov/coronavirus/2019ncov/daily-life-coping/managing-stress-anxiety.html.

2020 PWH ® DISTANCE LEARNING Influence Redefined … Be the Leader You Were Meant to Be, Monday to Monday® Are your virtual interactions as effective as they can be or are you grateful when they’re over? We are living in a world called noise. 24/7 we are receiving messages and managing distractions working virtually. What do you need to do to stand out above the noise your listeners are experiencing to influence them? This virtual experience will give you the opportunity to take a closer look at how influential you are and how to stand above the noise.

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• Reputation Management; see yourself as others see you in a virtual environment. Are you as good-or bad as you think you are when you communicate with influence Monday to Monday®? • Communicate with brevity and clarity that keeps your listener engaged from start to finish and build trust through your message and body language. • A proven, step-by-step method for creating influence that moves people to action long after an interaction is over.

• Project confidence, credibility and impact. • Identify how your delivery impacts your message and listeners experience. • Communicate concise and consistent messages to clearly manage expectations and minimize miscommunication. • Deliver a message your listener wants to receive, not only what you want them to hear.

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

Automotive-related news The Bronco is back A quarter of a century has passed since the Ford Bronco disappeared from dealerships, but that’s set to change with the introduction of the 2021 model this year, CNET reported. Rocking two different body styles, in addition to a smaller Bronco Sport variant that will certainly be better than the Bronco II, Ford’s latest SUV is ready to recapture buyers that might have flocked to vehicles like the Jeep Wrangler. With the exception of certain truck trims, Ford hasn’t had a properly bulky off-roader in a long time.

Uber will let California drivers set their own rates According to NBC News, Uber said in July it would let drivers across the state of California set their own rates as 56

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a function of the company’s price “multiplier” – used in Uber’s so-called “surge” pricing. The move builds on a pricing experiment that began in January in Sacramento, Santa Barbara and Palm Springs. Previously, drivers had no ability to set their own rates, which was one of the primary critiques of proponents of AB5, the state law that took effect at the beginning of the year, according to the report. The law attempts to ensure that so-called gig economy workers are considered employees rather than independent contractors. Under state labor law, employees are eligible for consideration benefits, including workers’ compensation, unemployment, unionization rights and more. Numerous companies including Uber save millions annually by avoiding such financial costs.

Rocking two different body styles, in addition to a smaller Bronco Sport variant that will certainly be better than the Bronco II, Ford’s latest SUV is ready to recapture buyers that might have flocked to vehicles like the Jeep Wrangler.

Honda signs agreement with electric car battery manufacturer Honda will purchase a 1% stake in a Chinese electric vehicle battery maker as part of a joint development of batteries for new energy vehicles (NEVs) and joint R&D into next-generation fundamental technologies. Contemporary Amperex Technology Co., Limited and Honda have signed an agreement to form a comprehensive strategic alliance on new energy vehicle batteries to strengthen their strategic partnership and promote the popularization of electrified vehicles. This agreement will enable the two companies to begin discussions on a broad range of areas including joint development, stable supply, and the recycling and reuse of batteries. CATL and Honda will conduct joint development on NEVs batteries and joint R&D into fundamental technologies, aiming for their future application. CATL will provide stable supply of NEV batteries to Honda,

mainly for battery electric vehicles (BEVs). The first model equipped with a CATL battery is scheduled to be launched in the Chinese market in 2022. This alliance will be further expanded to the global level in the future, the companies said in a release. Moreover, battery recycling and reuse also will be a topic in further discussions between CATL and Honda. Honda has acquired approximately 1% of CATL shares through the nonpublic issuance of stocks, which makes Honda a leading strategic partner of CATL.

Kia struggling to keep up with Telluride demand The good news for Kia is that its 3-row SUV, the Telluride, has been a hit with U.S. consumers. The bad news is, the auto manufacturer underestimated just how popular it would be. According to The Car Connection, when the Telluride debuted in February 2019, Kia set an annual production capacity of 60,000 Tellurides at its only U.S. production facility in West Point, Georgia, where certain trims of the Sorento and Optima are made as well. “We blew past that and ramped it to 100,000 units,” James Bell, director of communications for Kia, told The Car Connection. Meeting demand “is going to be tight even at 100,000, but it’s the best we can do.” The pandemic did Kia and Telluride buyers no favors. In May Automotive News reported the Georgia factory was shut down for nearly eight weeks then resumed with just one shift out of an abundance of caution. The factory’s back up to three shifts, but it’s “not full guns on production, yet,” Bell said, noting a parts shortage from a supply chain in Mexico.

Hertz sells thousands of vehicles in its fleet at discount prices After filing for Chapter 11 bankruptcy protection May 22, car rental company Hertz announced this summer it was selling vehicles in its fleet at discount prices, USA Today reported. The coronavirus pandemic forced several companies strained before the crisis to file for bankruptcy to try to survive. J.C. Penney, Neiman Marcus and Tuesday Morning are among the chains that filed for bankruptcy since the start of the pandemic. Hertz competitor Advantage Rent A Car filed for court protection from its creditors May 26. Hertz’s fleet consists of roughly 700,000 rental cars, which have greatly diminished in value because of a sharp drop in used car prices caused by a freefall in auto sales stemming from the pandemic. www.repertoiremag.com

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September 2020

NEWS

A Continuation AHA report: Financial impact of COVID-19 expected to top $323 billion in 2020 The financial strain facing hospitals and health sys-

tems due to COVID-19 will continue through at least the end of 2020, with patient volume expected to remain well below baseline levels, according to an AHA report released this summer . The report estimates an additional minimum of $120.5 billion in financial losses, due in large part to lower patient volumes, from July 2020 through December 2020, or an average of $20.1 billion per month. These estimates are in addition to the $202.6 billion in losses the AHA estimated between March 2020 and June 2020 in a report released earlier in the year.

This brings total losses for the nation’s hospitals and health systems to at least $323.1 billion in 2020. “And while potentially catastrophic, these projected losses still may underrepresent the full financial losses hospitals will face in 2020, as the analysis does not account for currently increasing case rates in certain states, or potential subsequent surges of the pandemic occurring later this year,” AHA said in a release. If the current surge trends continue, the financial impact on hospitals and health systems could be even more significant. 58

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“This pandemic has shown once again why America’s hospitals and health systems are indispensable cornerstones of their communities. However, hospitals and health systems are in the midst of the greatest financial crisis in our history, as we continue to fight this pandemic at the same time that non-COVID patient visits remain down,” said Rick Pollack, AHA president and CEO. “While we appreciate the support to date from Congress and the Administration, this report clearly shows that we are not out of the woods. More action is needed urgently to support our nation’s hospitals and health systems and front-line staff.” The report found that hospitals and health systems currently report average declines of 19.5% in inpatient volume and 34.5% in outpatient volume relative to baseline levels from 2019. In addition, most hospitals and health systems do not expect volume to return to baseline levels in 2020. The report’s analysis does not account for currently increasing case rates in certain states, or potential subsequent surges of the pandemic occurring later this year. While the financial impacts estimated in this report are comprehensive, and take into account the additional costs of acquiring personal protective equipment (PPE) as patient volumes return, they importantly do not include any direct COVID-19 treatment costs hospitals may incur over this time period, particularly if there are future surges of additional cases, AHA noted. Other expenses, such as increased acquisition costs for drugs and non-PPE supplies and equipment, are also not included in the estimates. “Thus, the estimated losses in [the] report do not reflect the full financial impact of the pandemic on America’s hospitals and health systems in 2020,” AHA said. “Nor do they include the long-term effects of the pandemic beyond 2020.”

Walgreens announces large-scale rollout of physicianled primary care clinics

Walgreens Boots Alliance, Inc. and VillageMD an-

nounced this summer that Walgreens will open 500 to 700 “Village Medical at Walgreens” physician-led primary care clinics in more than 30 U.S. markets in the next five years, with the intent to build hundreds more thereafter. The clinics will integrate the pharmacist as a critical member of VillageMD’s multi-disciplinary team, and will be staffed by more than 3,600 primary care providers, who will be recruited by VillageMD, according to a release. The clinics will accept a wide range of health insurance options, and offer comprehensive primary care across a broad range of physician services. Additionally, 24/7 care will be available via telehealth and at-home visits. More than 50% will be located in Health Professional Shortage Areas and Medically Underserved Areas/Populations, as designated by the U.S. Department of Health and Human Services. This rollout follows a trial with five in-store clinics in the Houston, Texas area, which produced very strong results after opening last November including high patient satisfaction, with Net Promoter Scores over 90, the release said. Data from current Village Medical clinics shows that an integrated pharmacy and primary care approach

increases medication adherence and contributes to improved patient outcomes. “This rollout is a major advancement of one of Walgreens Boots Alliance’s four key strategic priorities, Creating Neighborhood Health Destinations,” said Stefano Pessina, executive vice chairman and CEO, Walgreens Boots Alliance. “These clinics at our conveniently located stores are a significant step forward in creating the pharmacy of the future, meeting many essential health needs all under one roof as well as through other channels.” “In the U.S., we spend $4 trillion per year on healthcare, over 85% of that is tied to patients with chronic diseases. To improve our healthcare system and reverse the trajectory of health spending, we must meet the needs of all patients. This partnership allows us to unleash the power of primary care doctors and pharmacists, enabling them to work in a coordinated way to enhance the patient experience,” said Tim Barry, chairman and CEO, VillageMD. “The results of our initial pilot clinics highlight that these outcomes are infinitely achievable.” Most of the clinics will be approximately 3,300 square feet each, with some as large as 9,000 square feet. They will optimize existing space in the store, which will also still provide a vast range of retail products to customers. www.repertoiremag.com

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September 2020

NEWS

Industry News

Road Warriors podcast with guest Aaron Novak A new episode of Road Warriors is now available featuring special guest Aaron Novak. Aaron was formerly with PSS/McKesson and now an entrepreneur in Jacksonville, Florida. One of Aaron’s companies is a Sandler Systems franchise. “Given the ‘new normal,’ I thought this podcast would be timely. This is a little different than a traditional Road Warriors episode, in that I asked Aaron several questions around sales and sales leadership as we start to sell in this new virtual environment and as we guide customers through allocation,” says Scott Adams, publisher of Repertoire. To listen to the podcast, visit: repertoiremag.com/ road-warriors-podcast-episode-17-aaron-novak.html.

Midmark announces retirement of vice president, global supply chain Karl Weidner Midmark Corp., announced the retirement of Karl Weidner, vice president, global supply chain. Weidner plans to retire near the end of 2020 after a forty-year career with Midmark. Weidner started his career with Midmark as an industrial engineer and along his journey held the titles of Karl Weidner plant manager, director of service and quality, and vice president of manufacturing before earning the title of vice president, global supply chain where he serves today. Also, he has been actively involved in local business and workforce development initiatives, working collaboratively with state and local government officials along with private businesses and public educators. 60

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Helping implement the Midmark Production System (MPS) is only one of Weidner’s many successful accomplishments during his tenure. His leadership in this transformation continues to deliver significant value to Midmark and its customers. He is most proud of his team’s willingness to adopt, and adapt, to new ideas and witnessing countless teammates grow, develop and accomplish many wonderful things. Mike Walker, chief operations officer stated, “On behalf of the entire Midmark organization, I want to thank Karl for his many significant contributions over the last forty years, a period of substantial growth and transformation to meet the ever-changing needs of our customers in healthcare. Karl has thrived on working with people who shared the same desire to make a difference at Midmark. And his passion to make a difference for this organization has certainly made a great and lasting impact. I am happy for Karl that he will be able to spend more time with his family and dedicate more time to the community, travel, his hobbies and many other things important to him. We wish nothing but the best in his retirement.”

Kroger Health develops COVID-19 test home collection kit Kroger Health has developed a COVID-19 test home collection kit for safe detection of the COVID-19 virus infection in patients. It allows individuals to collect nasal swab samples at home with the guidance of a healthcare provider through telehealth consulting. It was been authorized by the FDA under EUA. Kroger Health collaborated with Gravity Diagnostics (Covington, KY), a CLIA laboratory, for processing the COVID-19 samples collected by the kit.

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