vol.25 no.11 • November 2017
TEN MANUFACTURER REPS TO WATCH
repertoiremag.com
How you and your manufacturer partners can make a powerful selling team
NOVEMBER 2017 • VOLUME 25 • ISSUE 11
PUBLISHER’S LETTER Bringing Back the Good Old Days .................... 6
CONTRACTING EXECUTIVE PROFILE Elizabeth Vinson
Director of strategic sourcing, Yale New Haven Health, New Haven, Connecticut.........................................8
TRENDS
TEN MANUFACTURER REPS TO WATCH
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HEALTHY REPS
Good for the heart? Good for the brain.
54
High Blood Pressure and Kids
Pediatrics group issues guidelines.................................... 34
Diabetic Eye Disease: The Facts
Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year.............................. 38
Patients First
Who’s missing from the healthcare reform debate?.................................................... 46
repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2017 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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NOVEMBER 2017 • VOLUME 25 • ISSUE 11
WINDSHIELD TIME
Your car: A mind of its own
HIDA GOVERNMENT AFFAIRS UPDATE HIDA Members and SNS Discuss Preparedness During Streamlining Healthcare Conference......... 64
SMART SELLING
Use Social Media to Reach Beyond Your Base
Self-driving, or autonomous vehicles are about 10 years away
58
QUICKBYTES
Technology news
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66 REP CORNER
Parts Unknown Iowa-born and bred, Brandon Young calls on an even vaster expanse today
68 TRENDS U.S. Healthcare at a Glance........................................ 72
INDUSTRY NEWS News........................................................................................... 74
PUBLISHER’S LETTER
Bringing Back the Good Old Days This issue is one of my favorites of the year, because I love Thanksgiving, and I always
enjoy reading about the manufacturer reps to watch. As I was reading through the writeups on each of the superstars, it struck me how important their role truly is to all of us. I had 20-plus meetings with manufacturers during HIDA this year, and in over half of those meetings they told me for 2018 they are bringing back ride days and challenging their reps to get in the car and work with you. It was incredibly refreshing after listening to so many of them talk about calling on the IDN directly for the past few years. I talk a lot about how today’s distribution rep has to be the quarterback. Well, every QB needs an offensive coordinator, which I would say is your manager. You also need a head coach, which I would categorize as your corporate office. They are setting the direction of the team. While both of those roles are important, it may be the position coaches that truly shape a team and help them sharpen their skills. In my opinion, your manufacturer reps are your position coaches. They have the ability to make you look like a superstar in front of your clients. These professionals can bring real value to you and your clients. Over the next few months, my challenge to you is to take a step back to the days when we all went out and tried to help each other sell more stuff. Put a manufacturer rep in your car one day a week over the next quarter – whether you think you need to or not. Who knows, maybe they will deliver some sales that help you gain a new customer or hit your plan for the year. Lastly, during this holiday season I wanted to say thank you for allowing us to do what we love, which is to support the channel through Repertoire Magazine. I never take the voice of our magazine or its audience for granted. Next year will be Repertoire Magazine’s 25th anniversary. We couldn’t do what we do without the support of the suppliers who advertise in these pages and without you, our reader. Thank you!
Scott Adams
Happy Thanksgiving, R. Scott Adams
repertoire is published monthly by Share Moving Media 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia; www.sharemovingmedia.com
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Mark Thill lthill@sharemovingmedia.com managing editor
Graham Garrison ggarrison@sharemovingmedia.com editor-in-chief, Dail-eNews
Alan Cherry acherry@sharemovingmedia.com art director
Brent Cashman bcashman@sharemovingmedia.com
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vice president of sales
Jessica McKeever
jmckeever@sharemovingmedia.com (800) 536.5312 x5271 director of business development
Alicia O’Donnell
aodonnell@sharemovingmedia.com (800) 536.5312 x5261 sales executive
Tyler Moss
tmoss@sharemovingmedia.com (800) 536.5312 x5279 sales executive
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Lizette@sharemovingmedia.com (800) 536.5312 x5266
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Brian Taylor btaylor@ sharemovingmedia.com circulation
Laura Gantert lgantert@ sharemovingmedia.com
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2017 editorial board Bill McLaughlin Jr. : IMCO Bob Miller : Gericare Medical Supply Linda Rouse O’Neill : HIDA Brad Thompson : NDC Chris Verhulst : Henry Schein
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CONTRACTING EXECUTIVE PROFILE
Elizabeth Vinson Director of strategic sourcing, Yale New Haven Health, New Haven, Connecticut
Editor’s note: Elizabeth Vinson was featured as one of the “Ten People to Watch in Healthcare Contracting” in the Journal of Healthcare Contracting, a sister publication to Repertoire, read primarily by supply chain executives in multihospital systems, IDNs and group purchasing organizations.
As a registered dietician, Vinson started her 35-year career in healthcare as a
director of food services for a 300-bed Connecticut hospital. Over time, she was promoted to the role of director of materials management (DMM). For the next 10 years, she worked as a DMM for a couple of different hospitals. In 2001, she joined Neoforma Inc. as a regional director, providing EDI and data cleansing solutions to hospitals. When Neoforma was acquired by GHX, she moved to the Advisory Board Company to support its supply chain management business intelligence solution. “It was during my tenure with the Advisory Board Company that I became even more passionate about helping hospitals figure out how to leverage data to drive savings across all categories of non-labor spend,” she says. She joined Yale New Haven Health eight years ago. Vinson leads a team of four Elizabeth Vinson managers and 60 employees, who are responsible for sourcing, negotiating Yale New Haven Health and procuring all supplies and services (YNHHS) is Connecticut’s for YNHHS’s five acute-care hospileading healthcare systals, ambulatory sites and physicians’ tem, with 2,563 licensed offices. Her department also has strabeds across five hospitals tegic relationships with four affiliate – Bridgeport, Greenwich, hospitals in Connecticut, and proLawrence + Memorial, Yale vides supply chain services to them. New Haven and Westerly; as Her teams work through the health well as Northeast Medical system’s value analysis structure, colGroup, an 800+ physician laborating with clinicians, physicians foundation of primary care and staff to establish contracts for a and medical specialists. formulary of supplies and services.
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JHC: What is the most challenging and/or rewarding supplychain-related project in which you have been involved in the past 12-18 months? Elizabeth Vinson: Yale New Haven Health’s annual non-salary spend is over $1 billion. We have historically leveraged nine interdisciplinary “Non-Labor Committees” (NLCs) to drive product and service savings projects. Examples of the NLCs included cardiac services, surgical services, pharmacy, IT facilities, med/surg (general med) and service contracts. We were doing great work, but we wanted to get to the next level and really change behavior. So we have worked with executive, physician and nursing leaders across the health system to establish the next iteration of our committee structure. We now have a Clinical Governance Committee (CGC), chaired by a surgeon, with physician and nursing representation across our health system. The CGC is taking an active role in reviewing project analytics with us, prioritizing initiatives and convening task forces to work with
Supply Chain. Through these physician-led task forces, we have been able to make sustainable decisions based on clinical evidence, reducing variation and driving high quality patient care. The physician-led task forces have driven record-breaking savings for Yale New Haven Health. JHC: Please describe a project on which you look forward to working in the next year. Vinson: In addition to meeting our financial goals to drive $50 million in nonlabor reduction in the next fiscal year, I am excited about four major projects on which the supply chain team will work over the next 12 months. Any one of these projects could be allconsuming, but it is exciting to be part of a team that is tackling all four simultaneously: •W e are in the midst of rolling out a Governance Structure, similar to the CGC, for other key areas of non-labor. Examples include Purchased Services and Pro Fee, Nursing, Operations Governance and Ancillary Services. •T wo hospitals joined YNHHS last year, and we are integrating our supply chain staffs, policies, procedures and savings initiatives. •W e are upgrading our Lawson ERP System to the new INFOR 11 cloud-based Supply Chain Integrated Business Planning solution. This will dramatically change the way we perform core strategic sourcing functions. •W e are finalizing a business plan to build a dedicated integrated service center for our health system and affiliate organizations. Our plan is to partner with our med/surg distributor to provide the traditional distribution services while our internal team focuses on other services to potentially centralize within the new building. JHC: In what way(s) have you improved the way you approach your job or profession in the last five to 10 years? Vinson: First, I have become extremely data-driven. Earlier in my career, I would approach meetings, projects, challenges and conversations with a “wait and see” attitude. Today I am extremely prepared for whatever the
task is. That involves analyzing data and fact finding, taking the time to identify stakeholders, understanding both internal and external data, initiating informal conversations, etc. Second, I have become very comfortable with change. Having an open-minded approach and embracing change has been a critical element to successfully navigating the supply chain healthcare world. At YNHHS I’ve been extremely fortunate to work with high-caliber professionals who are “change agents” in their respective fields. This provides a very fulfilling work environment, which energizes me every day!
I have become very comfortable with change. Having an open-minded approach and embracing change has been a critical element to successfully navigating the supply chain healthcare world.
JHC: What do you need/ want to do to become a better supply chain executive in the coming year(s)? Vinson: I want to enhance and improve our ability to recruit, retain, develop and promote highquality people to be part of our team. A colleague and I presented at Vizient’s “Connections Summit” conference in Las Vegas, and our session topic was “Investing in Our Employees to Become Future Supply Chain Leaders.” According to the 2016 Association for Healthcare Resource & Materials Management (AHRMM) “Comparison of Compensation Survey,” 66 percent of the 1,025 professionals who responded to the survey are over 46 years of age. Our demographics are similar; we have an aging workforce. As a leadership team, we are committed to employee development for our younger staff and investing in strategic succession planning. Some of the steps we have undertaken include sponsoring Certified Materials & Resource Professional (CMRP) certification training classes, encouraging staff to participate in LEAN training classes, and reimbursing employees to join AHRMM and take the CMRP exam.
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TEN MANUFACTURER REPS TO WATCH
“I
How you and your manufacturer partners can make a powerful selling team
ron sharpens iron,” says Peter Green, MedTech/MedCare, quoting the Book of Proverbs. (The full quotation is, “As iron sharpens iron, so one person sharpens another.”) Green believes that manufacturer and distributor reps make a powerful selling team, if
they work together. So do the other reps among this year’s “Ten Manufacturer Reps to Watch” feature. See what we mean by reading what they have to say about successful selling.
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Ten manufacturer reps to watch Alex Cathro
A Cathro Medical Representing Bovie Medical Repertoire: What are the two or three most important things you can do for your distributor rep partners to enhance their sales? Alex Cathro: First, after 35 years as a distributor rep myself, I know their business. I know their fears, concerns, challenges and the importance of hitting their numbers. When I’m in an office, with or without the rep, they know that I have the confidence and experience to interact with the customer the way they would. Second, I know the importance of keeping their profit margins up. When I’m with a customer, I know how to present the features and benefits of the products and close the sale.
Repertoire: Name two or three ways distributor reps can help you add value to their accounts and increase sales. Cathro: The biggest way a distributor rep can use me to add value to their account is get me in front of the customer! I understand customers are different, with IDNs and hospitals acquiring practices. However, there are still small group practices and single doctors out there fighting to survive. The only way to survive is for them to either cut costs or increase revenue. Because cutting costs is not really an option, their only avenue to stay in business is to generate more income. These are the customers the distributor reps need to focus on, because they are the accounts that can create leads and generate business. Showing these customers how they can generate more revenue endears them to the rep, tightening up their relationship as the trusted advisor. We need to show the customer how to enhance their productivity and patient relationships with the newest equipment available. This shows the account that their rep cares for them and is concerned about the success of their practice. If we do this and close the sale, the rep has a better chance of keeping the margins up.
What is there not to like about riding with reps?
Repertoire: What is the biggest change you anticipate in medical product sales in the next five years? Cathro: Currently, the elephant in the room are companies like Amazon. What I’m hearing on the street from the distributor reps is their concern about how this will affect their business. It seems like these companies are taking over, but
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I disagree. I don’t believe these huge send-you-anything distributors are set up to deliver with the level of service that healthcare professionals expect, unless somehow they align themselves with a major dealer. I believe we will see a rise in small independent distributors that specialize in niche markets.
Repertoire: What do you like – or dislike – about ride-days with distributor reps?
taking orders. It always works best with two people, because if one person forgets a point, the other can bring it up. Cold calls are much more fun and easy when there are two people working together. Besides, if I’m in your car, I’m not in someone else’s car. And here’s an aha moment: If I get a lead at an account that has no distributor rep, who am I going to turn it over to? Probably someone I’ve ridden with.
Cathro: What is there not to like about riding with reps? It is harder these days for them to find the time to spend with us, because of the amount of work that is keeping them out of the field. But if we are riding together, we are focusing on my particular products, and hopefully that will remain the case for a few days after the ride. Second, we get to know each other better, establish a closer relationship, and I learn how they conduct their business and communicate with their customers. As a result, they develop trust in me to work with their accounts and can send me to an account without them. Third, and most important, it’s fun.
Repertoire: Do you have a favorite ride-day story?
Repertoire: Do you think distributor reps should embrace ride days?
thing that stands out in my memory is the fun we’ve had on those cold-call days. One day in particular, another rep and I pulled so many tricks on each other I had to leave in the middle of the call to go out to the parking lot and laugh. Many of those occasions ended up with amazing sales. It’s been a blessing to work with everyone on the distribution side and now as a manufacturer’s rep. Bovie and my other lines are great companies to work for, and I am thankful for all of them. In 1983 at a Midmark Power School, I met Scott Fanning and will always remember his words; “If two people can laugh together, they can’t be too far apart.” And that still holds true today.
Cathro: As I mentioned, I’ve been in this industry for 37 years, so I have many, many ride-day stories. The main
If I get a lead at an account that has no distributor rep, who am I going to turn it over to? Probably someone I’ve ridden with.
Cathro: Absolutely they should! It is the best win-win situation. When I was a distributor rep, I rode with manufacturer reps as often as I could and increased sales because of it. Distributor managers ought to make it mandatory for new reps to ride with manufacturer reps. They learn more about products, thus increasing their profitability. By working together, we may not sell my product, but we may uncover a totally different opportunity for the distributor rep. When a rep is out with a manufacturer rep, he/she is actually selling, not just
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Ten manufacturer reps to watch Brian Colbey Senior sales specialist Abbott Point of Care Repertoire: What are the two or three most important things you can do for your distributor rep partners to enhance their sales? Brian Colbey: Follow up, follow up, follow up. • Customers live in an iPhone world, where information is easily accessible 24 hours a day. As such, they expect an immediate response from their distribution partners. Manufacturer partners need to be equally accessible, and assist in providing that information. • Follow-through, that is, doing what you will say you will do. Credibility and honesty are not easily earned, but easily lost. Following through on commitments is crucial. • Finally, being as knowledgeable as possible about your product portfolio, about state and national regulations and their impact on running an in-house lab, and knowing how your product can help improve their practice by providing better patient outcomes.
Repertoire: Name two or three ways distributor reps can help you add value to their accounts and increase sales.
Follow up, follow up, follow up.
Colbey: • Pre-call planning. When distributor partners spend time with their manufacturer partners discussing targets and mapping out their schedule, everyone is better for it. You give me a breakfast or lunch to discuss what we are looking for, and I will leverage that into a successful ride day. • A follow-up to that is, when scheduling time with a potential customer, a little pre-qualification goes a long way (e.g., number of patients per day, payer mix, why they may be interested, what concerns they may have). This allows us to arrive at the meeting with solutions.
Repertoire: What is the biggest change you anticipate in medical product sales in the next five years? Colbey: With the consolidation of health systems and the growth of IDNs, practices will be forced to focus more on patient satisfaction and compliance
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rather than the old reimbursement/fee-for-service model. ROI selling will no longer be applicable.
Repertoire: What do you like/dislike about ridedays with distributor reps? Colbey: Ride-days are an important way to build momentum with my distributor reps. In general, getting the opportunity to get to know them better, see their accounts from their perspective and understanding what really drives their sales is crucial to running a strong territory. I firmly believe that by developing these relationships, I have been able to bridge the gap in my territory, allowing for success here at Abbott, and gaining some true friends within this industry.
tell you, they really let us have it as to why they were so dissatisfied. We listened to their issues, and allowed them to vent. Afterwards, we asked them if they would allow us to work on a solution to their problem, and if we could fix it, then perhaps they would give our product a look. After doing a ton of work, with no guarantee of a close, we came up with a solution for their problem.
Credibility and honesty are not easily earned, but easily lost.
Repertoire: Do you think distributor reps should embrace ride days? Colbey: Distributors have so many products in their bag (200,000 on average), that they can’t be experts on any. The best way to provide value to their customers is to bring in the product expert (manufacturer partner), and thus give them the full scope of what is available to their practice. Ride days are the easiest way to accomplish this goal.
The account was so pleased, they decided to purchase two Piccolo units and signed a volume commitment for reagents for over $200,000 per year. That close represents one of the larger reagent closes for a single user, and it came from a highly dissatisfied customer off of a cold call. Needless to say, it was one of the closes I am most proud of; that it came with one of my favorite reps just makes it that much sweeter.
Repertoire: Do you have a favorite ride-day story? Colbey: I went into an account with a South Jersey distribution rep a while back, and when we told them we were there to discuss Abbott products, they brought us right back to the office manager. We were both very excited, as it was a cold call. Little did we know that they wanted to speak with us because they had a previous problem with another division of Abbott. Let me
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Ten manufacturer reps to watch Eric Smith
Instrument specialist/non-acute Cepheid Repertoire: What are the two or three most important things you can do for your distributor rep partners to enhance their sales? Eric Smith: • Know your audience and the right questions to ask them. For example, focus on technical details with the clinical folks. Save the topic of workflow efficiencies or how your product will impact the bottom line for the key stakeholders. • Wait to position your product until after you’ve found a need. Highlighting features and benefits before understanding the need will leave your customer with information, but not necessarily increased interest. Experience has shown me there is a direct correlation between having a champion within the account and the likelihood of closing the deal. • Be a consistent resource your reps can count on that adds value to their customers. Making a point to keep current on topics that are keeping our customers awake at night can allow for a more consultative dynamic rather than a sales-focused monologue. Learning the challenges that our customers are faced with can, in turn, open the door to a productive conversation. If the takeaway is seeing my product help the customer meet their quality measures, the right seeds have been planted.
I am often impressed by distributor reps’ ability to multitask while maintaining a keen ear to what the needs of their accounts are.
Repertoire: Name two or three ways distributor reps can help you add value to their accounts and increase sales.
Smith: • Referrals and warm introductions to key stakeholders. My distribution partners are my No. 1 customer. Building individual relationships and earning their trust can take time, but is the key to growing a robust sales funnel. Nothing creates momentum like some solid wins generating a healthy reagent trail. Once that trust is established, other opportunities open up, not only with that rep but with their counterparts as well. Also, many groups, such as pediatricians, belong to specialty networks, which can also open up referral opportunities.
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Bottom line: Leverage your strong relationships to create new alliances and broadcast your reps’ successes to their peers and sales leaders. • Encourage pre-qualifying the current account base to help identify target opportunities. Allocate time to hone in on accounts that may be a good fit for a focused product. Getting qualified leads with solid account information, such as volumes and test menu needs, can be invaluable for the front end of a business discussion.
Repertoire: What is the biggest change you anticipate in medical product sales in the next five years?
Repertoire: Do you think distributor reps should embrace ride-days? Smith: I believe ride-days should be embraced by distributor reps who are looking for ways to continue to educate themselves and their customers on products and services that can bring value to their practice. That said, it can be beneficial to the manufacturer rep and the distribution partner to have an initial meeting on the front end to discuss the value proposition and set the expectations for the day.
Highlighting features and benefits before understanding the need will leave your customer with information, but not necessarily increased interest.
Smith: Thanks to advancements in the arena of lab diagnostics, I believe there will be a continual paradigm shift away from centralized lab testing. As access to molecular quality results increase at the clinic level, providers will continue to gain confidence in the new methodology of instrumentation available to them in the POC environment. Bringing these high-quality results closer to the patient will positively impact clinical outcomes, reduce readmission rates, and promote antibiotic stewardship.
Repertoire: What do you like or dislike about ride-days with distributor reps? Smith: I see ride-days as great opportunities to get a glimpse into the day in the life of a distributor rep. I am often impressed by their ability to multitask while maintaining a keen ear to what the needs of their accounts are. At times it can be an exercise in patience, but if we’ve planned our day together, there are always positives to take away.
Repertoire: Do you have a favorite ride-day story? If so, can you briefly share it? Smith: Although not a typical ride-day, a favorite memory in the car with my reps was a fun activity that was a part of a regional team meeting. Splitting up into four groups, we set off on a scavenger hunt with a list of landmarks that were unique to the section of the city. The team that successfully located the most landmarks in the allotted time were crowned the winners. Not only was it a total blast, but a great opportunity to build relationships.
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Ten manufacturer reps to watch Christopher Hallmark Account executive Alere Repertoire: What are the two or three most important things you can do for your distributor rep partners to enhance their sales? Christopher Hallmark: Ask them to explain what the customer’s drivers are and why they sell what they sell into certain accounts. This enables me to focus on the customer’s needs and position product solutions accordingly. It’s equally important to understand their compensation model, so there is an understanding of product revenue differences and upsides, especially in today’s competitive market with newer technologies.
Repertoire: Name two or three ways distributor reps can help you add value to their accounts and increase sales. Hallmark: A key area of best practice is to prequalify accounts. It’s essential to know the account’s needs and who the true decisionmakers are, and have a pre-call strategy in place. Knowledge of MACRA and the correlation that point-of-care testing has with adherence to certain quality metrics and outcomes-based incentives is important. An example would be to identify those customers who still send out lab tests, such as hemoglobin A1c. From a simple fingerstick, they could now drive better glycemic control with these same patients internally and achieve better outcomes. This makes both the distribution representative and the manufacturer a valued partner and extension of the practice. The distributor representatives can identify those customers that are most in need of finding innovative ways to meet today’s quality objectives and at
Standing out in a crowded field is paramount to success.
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the same time improve patient lives by better managing their chronic and acute diseases through a better understanding of our entire portfolio. We have solutions for nearly every office they call on. Seeing and understanding all the nuances of today’s ever-changing landscape make them and us more effective in the eyes of the customer.
Repertoire: What is the biggest change you anticipate in medical product sales in the next five years? Hallmark: We are seeing the emergence of value-based payment models, thanks to MACRA. Providers will no longer be paid for providing services to people, but for keeping people healthy. I think we should begin to see tremendous growth in the amount of usable data being generated by the current healthcare system. Combing through this data will definitely impact the way we identify clinical patterns and/or trends, which could eventually open the door to improving those outcomes by refining our best practices.
Repertoire: What do you like/ dislike about ride-days with distributor reps? Hallmark: Starting with the “likes”: Ride-days give the manufacturer’s rep a direct path to the decision-makers within an account, or at least to an established audience in which to present products. These days are absolutely
more fruitful compared to the average cold call. The ride-day gives you much-needed time to build rapport with the rep and within the account. From there, it is up to you whether or not you can impress upon the rep your credibility and value to them. I view ride-days as a path to building and gaining trust. With trust, ride-days transition into a steady diet of warm leads and teed-up meetings, to the point where you can go into accounts without the rep to demo your products on their behalf! He or she has given you full rein inside the account because of how well you have performed in the car and in front of customers. The ride-day is essential, as it provides you a stage in which to perform on. There’s no tougher audience than a distribution rep, as they can make or break your existence and longevity as manufacturer’s rep. Now for the dislikes: First off, ride-days can be difficult to come by with reps, especially the more tenured reps with established books of business. It can be very frustrating to always ask for something and never get a call back or any inkling that you exist. This also can drive a wedge between you and the distribution rep, as your unanswered voice mails continue to clog up their phone and frustrate them even more. Ride-days can be too planned. Translation: The rep may only be giving you access to a ride-day because he or she is being forced to do so by their manager or organization. These days usually end up as the dreaded half-day experience. The rep is simply checking the box, because they simply do not have anywhere to take you. This is discouraging, but can also pose as a test. The one silver lining with the half-day experience is, you still have time to build rapport and get to know the rep. The biggest frustration really comes from knowing that I have a product or solution that is a fit for my rep, but they don’t realize it. In the end, perseverance and patience wins.
you to change this behavior. Bring them a lead, close a deal and push it to them – anything to create a sense of purpose and value. If they are not willing to work with you, give them a reason to consider it. I find those distribution reps who embrace the ride-day often walk away with some tidbit of knowledge regarding your product that they didn’t have before, or a newfound reality that was previously thought to be an obstacle. Again, I believe it is always up to me to bring value, differentiate my product and myself, and make working with me worth it. It has
My thought is that it is always up to me to bring value, differentiate my product and myself, and make working with me worth it.
Repertoire: Do you think distributor reps should embrace ride days? Hallmark: Yes and no. If you come across a distribution rep that wants nothing to do with ride-days, or is simply too busy to give you the time of day, it is ultimately up to
to be worth their time and energy, because after all, we are taking them away from their normal routine.
Repertoire: Do you have a favorite ride-day story? Hallmark: It’s not so much a favorite ride day, but a favorite story regarding what I did one time to increase my chances of getting more ride-days from some reps. Long story short, I attended the dinner cruise portion of a regional meeting dressed as the actual captain of the boat wearing the hat, coat, ascot – the whole nine yards. I got to the dinner early so I could greet each team member as they boarded the boat. Some of the reps actually thought that I was the real captain. It was hilarious! Mission accomplished. The icebreaker worked, and I was able to gain some significant mindshare moving forward with this team, especially the ones that had been avoiding me. Sure it was kind of embarrassing at first, but I wanted to make it fun and show that I was willing to do whatever to gain the attention of those reps who had for so long avoided my phone calls. I set myself apart, and sometimes that is exactly what it takes. Standing out in a crowded field is paramount to success!
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Ten manufacturer reps to watch Repertoire: What do you like/ dislike about ride-days with distributor reps?
Joe King
National account and distribution manager – ASC CareFusion-BD Repertoire: What are the two or three most important things you can do for your distributor rep partners to enhance their sales? Joe King: • I look to leverage our national manufacturing agreements with our customer groups for our clinically differentiated products to help generate leads/ referrals and protect existing business from competitive conversion. • I want to be a trusted partner. When working with a distributor rep, I want them to trust me to manage the sales process, to minimize the amount of work and streamline the process. • I will provide ancillary value-add educational services to distributor customers to help them differentiate themselves from their competitors.
Repertoire: Name two or three ways distributor reps can help you add value to their accounts and increase sales. King: Distributors that drive same-store sales with a single manufacturer will be able to provide more aggressive pricing agreements to their customers. If a customer has a significant spend on one product, look to see what else in the category can be switched to maximize savings. Bring us into accounts whenever possible. Let your manufacturing rep be an extension of yourself and partner with your customer to help differentiate products and increase your serviceability.
Repertoire: What is the biggest change you anticipate in medical product sales in the next five years? King: The market will continue to become more cost-sensitive, and regulatory complexity will increase. Companies that have the most diverse capabilities will be the best suited to help distributors and customers navigate these changes.
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King: Ride-days always have a significant ROI and help build strong relationships with the distributor while also enhancing the customer’s experience. The biggest inhibitor to a successful field ride is micromanaging your manufacturing counterpart by being overly guarded with your key relationships.
Repertoire: Do you think distributor reps should embrace ride days? King: Absolutely. As a distributor, you are a jack of all trades, and the demands on your time can limit your effectiveness. The more you lean on your manufacturing partners and trust them to be an extension of your business, the more you can focus on allowing them to organically grow with your existing accounts while allowing the distributor to focus on growing their overall market.
Repertoire: Do you have a favorite ride-day story? King: There was actually one field ride that defined my career, as well as the distributor’s. I was on a ride-along with a distributor rep in Tampa, Florida, who introduced me to an administrator of an ambulatory surgery center that was in development. This introduction parlayed into a meeting with the executive vice president of the development group. We signed their first preferred vendor agreement, and over the last five years have been the primary partner for 50+ of their new builds while this group grew into one of the largest national chains.
Katie Moothart Strategic account manager Terumo Medical
Repertoire: What are the two or three most important things you can do for your distributor rep partners to enhance their sales? Katie Moothart: • Be proactive to reduce their obligation and role in mutual pursuit of targets. • Deliver win-win-win solutions (customerdistributor-Terumo). • Bring VALUE. In today’s drastically changing healthcare environment, I talk less about “product” and have more value-based discussions/solutions, with a focus on reducing the cost of healthcare through improving patient experience and clinical outcomes, and improving operational efficiencies (Triple Aim). By teaming up with our distributor partners and offering these types of solutions to the customer, we provide a higher level of value-add.
Repertoire: Name two or three ways distributor reps can help you add value to their accounts and increase sales. Moothart: • Give me an opportunity to show my value and earn their trust. •C oordinate introductions with key decision-maker(s). It can be very beneficial when a distributor rep coordinates an introductory meeting with the key decision-makers in his/her account, and is able to share any pain points they are aware of. The more information we have regarding the customer’s needs, the more consultative we can be and offer a higher level of service, whether it is by offering solutions for standardization, compliance, cost of care, improved clinical outcomes, implementation planning, customized pull-through, product training, etc. •H ave balanced objectives. Balance the need for margin gains with the importance of offering the customer a value solution which can cement their client relationship in a competitive distribution environment.
Repertoire: What is the biggest change you anticipate in medical product sales in the next five years? Moothart: Steady consolidation of the healthcare marketplace. With a shift from fee-for-service to value-based reimbursement, healthcare providers will be increasingly focused on how cost, quality, and care decisions impact their facility. Providers being reimbursed based on performance as opposed to patient volume demands that MDE manufacturers and distributors focus on developing solutions and strategies for decreasing the costs of healthcare.
Repertoire: What do you like/ dislike about ride-days with distributor reps? Moothart: I like face time with both the distributor rep and customer to better identify the account’s challenges, objectives and initiatives, and to link/match our value solutions to their needs. Our goal is to achieve a win-win-win; the more interaction we have with the key decision-makers and the ability to understand their goals, the more successful we can be. I dislike the traditional “rideday” model of getting in a car with a field rep and hoping we meet with interested customers. In 2017, I want to make sure that is vetted out first. I also want to be sure there is an established “winwin-win,” a value prop is customized, a meeting plan is created, and a meeting with the decision-maker is coordinated in advance. Planning is everything!
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Ten manufacturer reps to watch AJ Pumphrey Health Systems Sales Sekisui Diagnostics
Repertoire: What are the two or three most important things you can do for your distributor rep partners to enhance their sales? AJ Pumphrey: Make sure they are armed with the right information about our company and products. Ensure we maintain a regular dialogue of offering support and collaboration of mutual opportunities.
Repertoire: Name two or three ways distributor reps can help you add value to their accounts and increase sales. Pumphrey: Focus on the needs of their customers and how our solutions can be in alignment with improving patient care. Qualifying opportunities, providing good contact details on decision-makers within the laboratory and purchasing. Beyond the decision-makers, it’s also good to discuss a proposed change with the techs, so they have buy-in and understand the benefits of changing their workflow with something new.
Repertoire: What is the biggest change you anticipate in medical product sales in the next five years? Pumphrey: More and more automation. This is both a benefit and concern, with many med techs retiring. To some, automation is seen as a benefit to offset the loss of quality techs. To others, it is perceived as a threat to their livelihood and contribution to laboratory medicine.
Beyond the decisionmakers, it’s also good to discuss a proposed change with the techs.
Repertoire: What do you like/not like about ride-days with distributor reps? Pumphrey: It’s great to have a day where reps are focused primarily on your products. In most cases, the byproduct of a ride day is the distributor rep coming prepared, and the manufacturer having more of their attention during the time together. It’s really a win-win for both.
Repertoire: Do you think distributor reps should embrace ride days? Pumphrey: Yes, I do. I think riding with a manufacturer has the added advantage of not just introducing a new product solution, but also offering technical expertise.
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Ten manufacturer reps to watch Dennis Swanton Corporate accounts manager Halyard Health
Repertoire: What are the two or three most important things you can do for your distributor rep partners to enhance their sales? Dennis Swanton: For a strong partnership, communication is key. For example, I periodically email my distributor reps to keep them up-todate on new products, key products, and Halyard-sponsored distributor monthly promotions. I also always make sure I am accessible to them. Following up with a rep is always critical, as that is how I can ensure timely delivery of samples or information.
Repertoire: Name two or three ways distributor reps can help you add value to their accounts and increase sales. Swanton: Co-traveling offers multiple ways for distributors to help: • First, when a distributor is open to a co-travel, they gain instant credibility. It conveys to the customer the importance of the partnership he or she has forged with the manufacturer. • Second, co-traveling gives you a reason to be in front of a customer, where the magic of selling happens. I can’t tell you how many times after we close a customer, the customer adds other products to the order. Often, it is a product they were purchasing through another distributor. • T hird, co-traveling gives you the opportunity to show customers new products. Even when I am not co-traveling, I still sample my distributor reps.
Following up with a rep is always critical, as that is how I can ensure timely delivery of samples or information.
Repertoire: What is the biggest change you anticipate in medical product sales in the next five years?
Swanton: The medical and dental business is going to experience many changes in the next five to 10 years. • The Affordable Care Act adds paperwork and cuts in reimbursement, which take away from time seeing patients and exploring new technology, and which make it harder to afford the latest technology.
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• Proactive care has already begun, requiring integration of physicians, hospitals, nursing homes, pathology labs and ancillary service providers. • Consolidation is continuing. Not only do we see integrated delivery networks buying and forming group practices, we also see private multilocation group practices growing in the primary care market. Additionally, there has been a surge in large private dental group practices with multiple locations. Consolidation will also continue to grow among manufacturers and distributors. As medical reimbursement continues to be squeezed, this will put increased pressure on manufacturers and distributors to shrink their margins. • Last, with the meteoric rise in e-commerce, manufacturers will need to continue to develop new products to stay relevant in the price game.
Repertoire: Do you think distributor reps should embrace ride days? Swanton: Of course they should. It is a great opportunity for the rep to work alongside the expert in their product line. A distributor rep has a hard job. They must know something about all the products in their bag.
Great distributor reps are like postal carriers – neither rain, sleet nor snow will keep the rep from making a sales call. The great reps always show up. Going on ride-days provides an opportunity to become more educated about a product, learn language specific to the product, and hear about the best ways to sell it.
Repertoire: What do you like/dislike about ridedays with distributor reps?
Repertoire: Do you have a favorite ride-day story?
Swanton: Ride-days are a great opportunity to work alongside my distributor partners and get to know who I am working with. After all, people buy from people, and people sell to people. When I ride with a rep, I feel like I have met a new business partner. One downside can be the weather. Getting in and out of a car in bad weather can get tedious. Great distributor reps are like postal carriers – neither rain, sleet nor snow will keep the rep from making a sales call. The great reps always show up.
Swanton: If I had to pick one story, it would be from my work with a rep in the Chinatown area of Flushing, New York. Given the parking challenges in this area, the rep and I parked our cars in a garage and walked together all day long. We must have visited 15 accounts. I was carrying samples and my briefcase to each. It was exhausting. The rep spoke several languages, and since this was Queens, it was a very diverse customer base. I think we sold over 30 cases of gloves and face masks on that day. That was an awesome experience.
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Ten manufacturer reps to watch Peter Green
MedTech/MedCare Representing Health o meter Repertoire: What are the two or three most important things you can do for your distributor rep partners to enhance their sales? Peter Green: My distributor reps are the bloodline to my success, and because of that, I make sure that I keep them up to date on a number of different facets that help them drive more value to their customers. Being a manufacturer rep for a number of different companies, I make sure that my distribution reps are aware of the innovation and the latest and greatest of medical devices, and how that can help their customers in today’s health system world. Promotions are great, and I keep that information in front of them, but the real value I try to bring my reps is solution selling, not transactional selling. The relationship is a two-way street: When they bring me an opportunity, it is my job to make them look as good as possible in that situation. That can come in a variety of ways – speaking at high levels on MACRA versus fee-for-service, customer field support, organically helping them upsell in every situation possible. My job, at the end of the day, is to make the person who called me about the opportunity look as good as possible in front of their customer – no more, no less.
The more we challenge each other as far as information upfront, the greater the closing percentage and chance of selling more product.
Repertoire: Name two or three ways distributor reps can help you add value to their accounts and increase sales.
Green: I constantly work with my reps to get in front of the key mobilizers within their accounts. Every customer is different; in some cases it may be a clinical nurse, in other situations it could be the GPO or even IT or project manager. I am constantly challenging my reps – as they challenge me – as to who are the key mobilizers. Understanding this allows us to be the most efficient in every call and to help increase our chances of closing business together. Iron sharpens iron: The more we challenge each other as far as information upfront, the greater the closing percentage and chance of selling more product. I just ask my reps to get me in front of every opportunity, large
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or small, and I will do whatever I can to help build on that opportunity. Also when the rep can extrapolate on the customer’s pain points, the better I can position the right product to help alleviate that pain point and make the rep look as good as possible.
Repertoire: What is the biggest change you anticipate in medical product sales in the next five years? Green: Today’s market is much different than it was two years ago – even one year ago. I see that only getting more challenging. With that being said, it means a ton of new opportunity for everyone if they are willing to embrace the changes and work through them. Understanding MACRA and HEDIS is essential – how that affects a doctor as feefor-service becomes a thing of the past. The reps who have a handle on solution selling and how to get to the key mobilizers will win in the end. There is more business available today, if you look in the right places. I look at every health system, IDN, accountable care organization and hospital as its own puzzle. Each is a little different, though they might look the same at first. Once you understand how and where the pieces go within each, you’ll find it becomes much easier to sell in that space.
I see riding with a manager, director or manufacturer partner. There has to be pre-call discussion or planning. In today’s world, some reps might have 45 sites that fall under one system. In the past, we would have tried to hit as many of those offices as possible. But it might make sense to maybe hit Biomed, Infection Control or a specific department to show how a product could benefit the entire system. This can only be done
My job, at the end of the day, is to make the person who called me about the opportunity look as good as possible in front of their customer – no more, no less.
Repertoire: What do you like/dislike about ridedays with distributor reps? Green: I am – and have always been – a fan of ridedays, but only if they are orchestrated in the right manner. I think of a ride-day with a rep the same as
with pre-call planning instead of just jumping in the car and going.
Repertoire: Do you think distributor reps should embrace ride days? Green: I don’t want to speak for anyone but me. I will only do a ride-day if there is a lot of work done on the front end so that we can be as efficient as possible and hit the ground running. The successful reps that I work with believe in them and use them when it makes sense. I have always been a believer in “strength in numbers,” so when done right, I think they are a major value-add for both the manufacturer and distributor rep.
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Ten manufacturer reps to watch Mark Tomchik Acuity Medical Representing Detecto
Repertoire: What are the two or three most important things you can do for your distributor rep partners to enhance their sales? Mark Tomchik: Encourage timely and frequent communication, mutually beneficial co-travel days, forwarding turn-order orders and leads, participating in dealer meetings, and most important, always do what you say are going to do … plus a little extra. If a rep needs a 5-7 percent discount to get the business, get them 7-10 percent off. If they need a quote in a day or two, deliver it in an hour. If a dealer rep needs help getting into one of your top accounts, offer to make the introduction and then set up the meeting and invite them to join you. Dealer reps are grateful for the extra help and always recommend your talents to others in their business. They won’t forget how much you helped, and keep in mind it is often the little things that matter the most in the relationship.
Repertoire: Name two or three ways distributor reps can help you add value to their accounts and increase sales. Tomchik: Distributor reps can help our mutual businesses by asking more customers about equipment replacement opportunities, invite manufacturer reps into customers’ new-construction or product-planning meetings, inform us about charity events and community outreach programs we can support, and simply get the manufacturer rep involved if a competitive situation exists. We can often secure demo units, offer white-glove delivery, equipment staging, local and custom pricing contracts including price protection, extended warranties, replacement parts programs, preventive maintenance programs, and more. We are very loyal to any dealer rep who brings us an opportunity, and commit to doing everything possible for them to secure the business.
Most of my early career mentors were from the distribution side of the business.
Repertoire: What is the biggest change you anticipate in medical product sales in the next five years? Tomchik: In five years I anticipate the biggest change in medical product sales will be the increase in end users and call points, as the aging boomers combined with the continued rise in life expectancy create higher utilization
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of disposables and spikes in medical equipment purchases. New construction due to the demand for more beds throughout the continuum will require medical product sales professionals to work closer with architects, equipment planners, and general contractors to be positioned for the capital equipment orders. Downward pricing pressure on commodities/disposables will become greater due to the increased utilization. Manufacturer and distributor sales professionals will need to be more organized, efficient, skilled, and diverse to handle the increased volume and customer base. Timely and effective communication between manufacturers and distributors will become even more critical to ensure mutual growth.
Repertoire: What do you like/ dislike about ride-days with distributor reps?
who do not sell direct, should be invited to co-travel more frequently. While many support grabbing coffee or lunch, or meeting at an account, few look to spend half a day or more in the field together. If the manufacturer rep is not prepared or falls short in some way, then I certainly would not expect them to co-travel again.
Repertoire: Do you have a favorite ride-day story? Tomchik: My favorite co-travel memories are bundled together, so choosing any one is hard, although I recall
The potential benefits of ride-days include advanced product training, mind-sharing, developing new business opportunities, meeting new customers, developing friendships and more.
Tomchik: Building relationships with a dealer rep is the minimum outcome, so there is no downside. The potential benefits include advanced product training, mind-sharing, developing new business opportunities, meeting new customers, developing friendships and more. Closing business is always the most enjoyable byproduct of co-travel, and I cannot recall the last time I or any of our Acuity Medical reps co-traveled and did not generate new business.
Repertoire: Do you think distributor reps should embrace ride-days? Tomchik: Absolutely dealer reps should embrace co-travel days, and the management team at the distribution level should make it mandatory they ride with every manufacturer rep at least once. Key vendors, or those like Detecto
co-traveling with a McKesson rep in a high security prison in Baltimore as being quite memorable. I would have to say my favorite memory over the years would be observing so many distributor reps develop amazing customer relationships. It is not surprising most of my early career mentors were from the distribution side of the business. Getting to know many dealer reps on and off the “playing field� has been a true gift and blessing. I look forward to many more co-travel days in the years to come, as the future is bright for all of us in medical product sales.
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High Blood Pressure and Kids Pediatrics group issues guidelines The prevalence of pediatric hypertension has in-
creased since 1988, and yet the condition often goes undiagnosed and untreated, according to a new report published by the American Academy of Pediatrics (AAP). The report, “Clinical Practice Guidelines for Screening and Management of High Blood Pressure in Children and Adolescents,” includes the Academy’s first set of guidelines for high blood pressure in children. It was published in the September 2017 issue of Pediatrics. An estimated 3.5 percent of all children and adolescents have hypertension, which is when the blood pressure remains abnormally high. Although the prevalence of hypertension has plateaued in recent years, elevated blood pressure readings often go undetected and untreated, the report says. The Academy convened a 20-person committee to develop the new evidence-based guidelines on pediatric hypertension, which serve as an update to the most recent set of guidelines, issued in 2004 by the National Heart, Lung, and Blood Institute, which was endorsed by AAP. The guidelines include new blood pressure tables based on normal-weight children. Previously, such tables
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included blood pressure measurements in children and adolescents who are overweight or obese – a condition that is likely to increase blood pressure. As a result, the new blood pressure values are lower than those used in prior guidelines and allow for a more precise classification of blood pressure according to body size.
Recommendations rated ‘strong’ The College’s recommendations rated “strong” are: • Oscillometric devices may be used for BP screening in children and adolescents. When doing so, providers should use a device that has been validated in the pediatric age group. If elevated BP is suspected on the basis of oscillometric readings, confirmatory measurements should be obtained by auscultation. • Children and adolescents with suspected whitecoat hypertension (WCH) should undergo ambulatory blood pressure monitoring (ABPM). Diagnosis is based on the presence of mean systolic blood pressure (SBS) and diastolic blood pressure (DSB) <95th percentile and SBP and DBP load <25%.
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TRENDS perform a physical examination to identify findings suggestive of secondary causes of hypertension.
• Children and adolescents who have undergone coarctation (narrowing of the artery) repair should undergo ABPM for the detection of hypertension (including masked hypertension, or MH).
‘Moderate’ recommendations
• Clinicians should not perform electrocardiography in hypertensive children and adolescents being evaluated for left ventricular hypertrophy.
Recommendations considered “moderate” include the following: • Blood pressure should be measured annually in children and adolescents ≥3 years of age.
• Regardless of apparent control of blood pressure with office measures, children and adolescents with chronic kidney disease (CKD) and a history of hypertension (HTN) should have blood pressure assessed by ABPM at least yearly to screen for MH. • Children and adolescents with CKD and HTN should be evaluated for proteinuria (excessive proteins in the urine).
Blood pressure should be measured annually in children and adolescents ≥3 years of age.
• Adolescents with elevated BP or HTN (whether they are receiving antihypertensive treatment) should typically have their care transitioned to an appropriate adult care provider by 22 years of age (recognizing that there may be individual cases in which this upper age limit is exceeded, particularly in the case of youth with special healthcare needs). There should be a transfer of information regarding HTN etiology and past manifestations and complications of the patient’s HTN. • I n children and adolescents being evaluated for high BP, the provider should obtain a perinatal history, appropriate nutritional history, physical activity history, psychosocial history, and family history and
• BP should be checked in all children and adolescents ≥3 years of age at every healthcare encounter if they have obesity, are taking medications known to increase BP, have renal disease, a history of aortic arch obstruction or coarctation, or diabetes. • Trained healthcare professionals in the office should make a diagnosis of hypertension (HTN) if a child or adolescent has auscultatory-confirmed BP readings ≥95th percentile at three different visits. • Ambulatory blood pressure monitoring (APBM) should be performed for confirmation of HTN in children and adolescents with office BP measurements in the elevated BP category for one year or more or with stage 1 HTN over three clinic visits. • Routine performance of ABPM should be strongly considered in children and adolescents with high-risk conditions to assess HTN severity and determine if abnormal circadian BP patterns are present, which may indicate increased risk for target organ damage. • ABPM should be performed by using a standardized approach with monitors that have been validated in a pediatric population, and studies should be interpreted by using pediatric normative data. • Home BP monitoring should not be used to diagnose HTN, masked hypertension, or white-coat hypertension, but may be a useful adjunct to office and ambulatory BP measurement after HTN has been diagnosed.
Source: Pediatrics, September 2017, Volume 140/Issue 3, Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents, http://pediatrics.aappublications.org/content/140/3/e20171904
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Diabetic Eye Disease: The Facts
Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year. Diabetic eye disease comprises a group of eye condi-
tions that affect people with diabetes, and that can cause severe vision loss or blindness: • Diabetic retinopathy. • Diabetic macular edema (DME). • Cataract. • Glaucoma. Diabetic retinopathy is the most common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness among working-age adults. Chronically high blood sugar from diabetes is associated with damage to the tiny blood vessels in the retina, leading to diabetic retinopathy. The retina detects light and converts it to signals sent through the optic nerve to the brain. Diabetic retinopathy can cause blood vessels in the retina to leak fluid or hemorrhage (bleed), distorting vision. In its most advanced stage, new abnormal blood vessels proliferate (increase in number) on the surface of the retina, which can lead to scarring and cell loss in the retina. People with all types of diabetes (type 1, type 2, and gestational) are at risk for diabetic retinopathy. Risk increases the longer a person has diabetes. Between 40 and 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy, although only about half are aware of it. Women who develop or have diabetes during pregnancy may have rapid onset or worsening of diabetic retinopathy.
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The early stages of diabetic retinopathy usually have no symptoms. The disease often progresses unnoticed until it affects vision. Bleeding from abnormal retinal blood vessels can cause the appearance of “floating” spots. These spots sometimes clear on their own. But without prompt treatment, bleeding often recurs, increasing the risk of permanent vision loss. If DME occurs, it can cause blurred vision. Diabetic macular edema (DME) is the build-up of fluid (edema) in a region of the retina called the macula. The macula is important for the sharp, straight-ahead vision that is used for reading, recognizing faces and driving. About half of all people with diabetic retinopathy will develop DME. Although it is more likely to occur as diabetic retinopathy worsens, DME can happen at any stage of the disease. Cataract is a clouding of the eye’s lens. Adults with diabetes are two to five times more likely than those without diabetes to develop cataract. Cataract also tends to develop at an earlier age in people with diabetes. Glaucoma is a group of diseases that damage the eye’s optic nerve – the bundle of nerve fibers that connects the eye to the brain. Some types of glaucoma are associated with elevated pressure inside the eye. In adults, diabetes nearly doubles the risk of glaucoma.
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TRENDS Detection Diabetic retinopathy and DME are detected during a comprehensive dilated eye exam that includes: •V isual acuity testing. This eye chart test measures a person’s ability to see at various distances. •T onometry. This test measures pressure inside the eye. • Pupil dilation. Drops placed on the eye’s surface dilate (widen) the pupil, allowing a physician to examine the retina and optic nerve. •O ptical coherence tomography (OCT). This technique is similar to ultrasound but uses light waves instead of sound waves to capture images of tissues inside the body. OCT provides detailed images of tissues that can be penetrated by light, such as the eye. A comprehensive dilated eye exam allows the doctor to check the retina for: • Changes to blood vessels. • Leaking blood vessels or warning signs of leaky blood vessels, such as fatty deposits. • Swelling of the macula (DME). • Changes in the lens. • Damage to nerve tissue.
Points to remember • All forms of diabetic eye disease have the potential to cause severe vision loss and blindness. • Diabetic retinopathy involves changes to retinal blood vessels that can cause them to bleed or leak fluid, distorting vision. • Diabetic retinopathy is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults. • DME is a consequence of diabetic retinopathy that causes swelling in the area of the retina called the macula. • Controlling diabetes – by taking medications as prescribed, staying physically active, and maintaining a healthy diet – can prevent or delay vision loss. • Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year. • Early detection, timely treatment, and appropriate follow-up care of diabetic eye disease can protect against vision loss. Source: National Eye Institute, part of the National Institutes of Health, https://nei.nih.gov/health/diabetic/retinopathy
If DME or severe diabetic retinopathy is suspected, a fluorescein angiogram may be used to look for damaged or leaky blood vessels. In this test, a fluorescent dye is injected into the bloodstream, often into an arm vein. Pictures of the retinal blood vessels are taken as the dye reaches the eye.
Prevention Vision lost to diabetic retinopathy is sometimes irreversible. However, early detection and treatment can reduce the risk of blindness by 95 percent. Because diabetic retinopathy often lacks early symptoms, people with diabetes should get a comprehensive dilated eye exam at least once a year. People
Vision lost to diabetic retinopathy is sometimes irreversible. However, early detection and treatment can reduce the risk of blindness by 95 percent. with diabetic retinopathy may need eye exams more frequently. Women with diabetes who become pregnant should have a comprehensive dilated eye exam as soon as possible. Additional exams during pregnancy may be needed. Studies have shown that diabetic patients who keep their blood glucose level as close to normal as possible are significantly less likely than those without optimal glucose control to develop diabetic retinopathy, as well as kidney and nerve diseases. Other trials have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss among people with diabetes.
Source: National Eye Institute, part of the National Institutes of Health, https://nei.nih.gov/health/diabetic/retinopathy
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TRENDS Four reasons why patients don’t schedule their diabetic eye exams Historically only 40-50 percent of diabetic patients receive the annual eye test for diabetic retinopathy, despite a recommendation by the American Academy of Ophthalmology that all patients with diabetes or pre-diabetes receive an annual retinal eye exam. Here are four reasons why. 1. Patients are typically asymptomatic until diabetic retinopathy has done damage to the retina.
2. P atients are also often uncomfortable making an appointment with a new, unfamiliar physician. 3. M any have transportation or proximity issues getting to the eye specialist. Patients are also challenged with finding a ride home after their eyes are dilated. 4. Patients can’t or don’t want to take time off work for an eye test that doesn’t seem urgent.
Source: Intelligent Retinal Imaging Systems, http://blog.retinalscreenings.com/4-reasons-whypatients-dont-schedule-their-diabetic-eye-exams
Eye exams in the primary care office Patients with diabetes should have a dilated retinal examination by an ophthalmologist or optometrist usually on an annual basis if no disease is present, and more often if warranted by the level of disease, according to the current standard of care. “This standard might be adequate if every person living with diabetes complied with their annual referral to visit the eye specialist,” says Chuck Witkowski, vice president and general manager, new healthcare delivery solutions, Welch Allyn. “But only 20 percent to 50 percent comply.” That’s true for a variety of reasons, including: • Lack of insurance or healthcare access. • Lack of knowledge of diabetes-specific ocular risk and health literacy. • Socioeconomic factors, cultural, and language barriers. • Patient logistics, time and cost associated with a separate office visit to a specialist. A solution – and macro trend – is to implement patient-centered systems in the right locations to deliver high-value care, says Witkowski. In many cases, that right location is the patient’s primary care physician’s office. In fact, implementing patient-centered systems to increase access to diabetic retinal exams in primary healthcare locations may help providers achieve the elusive 42
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“Triple Aim” of healthcare – improving the patient experience, improving population health, and reducing the cost of healthcare, he says.
A primary care solution Welch Allyn acquired Hubble Telemedical, Inc. in January 2015 and rebranded the solution offered by Hubble as RetinaVue™ Network, explains Witkowski. At the time of the acquisition, Hubble Telemedical’s services and technology had been refined for nearly a decade, started by a pioneer of teleretinal screening – Edward Chaum, M.D., Ph.D., who currently serves as chief medical officer of RetinaVue P.C. Advancements in non-mydriatic camera technology now make it more simple and affordable to offer diabetic retinal exams in primary care settings, says Witkowski. At $4,995, the suggested list price for the RetinaVue 100 Imager is two-thirds less than desktop fundus cameras, he says. The RetinaVue solution can be customized for regional or national integrated delivery systems or accountable care organizations, says Witkowski. Elements of a systemwide implementation can include: • A dedicated project management team, which scopes and fully operationalizes a solution that complements existing clinical workflow.
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• A mix of desktop and handheld retinal cameras, which are deployed based on the patient volume and workflow requirements of individual clinics. • Comprehensive population-healthmanagement and quality-reporting tools, which allow systems to view average image-quality scores, unreadable exam rates, exam volume, detected pathologies, and more – by clinic and by patient. • A fully supported, bi-directional EMR interface, which can be incorporated to efficiently place exam orders and return diagnostic reports to the EMR for easy access and review. • Evaluation of images by a board-certified ophthalmologist at RetinaVue P.C. (or by an ophthalmologist in the provider’s system). Reports are generally returned within one business day.
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The RetinaVue solution can help the physician practice improve its HEDIS scores/ratings, says Witkowski. The NCQA® /HEDIS® quality measure for the annual diabetic retinal exam (NQF #0055) is included in Medicare Advantage STAR Ratings, CMS Quality Payment Program, and Medicare Shared Savings Program measures for diabetes management. In addition, he says, NQF #0055 is a quality measure in the CMS Quality Payment Program: Percentage of patients 18 to 75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal or dilated eye exam (no evidence of retinopathy) in the 12 months prior to the measurement period. Distributor reps should focus on family physicians, internal medicine, multi-specialty, CHC, and endocrinology, says Witkowski. Any primary-care facility with a high population of diabetic patients and any facility with a high volume of A1C test-kit purchases is another high-potential customer.
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TRENDS
Patients First Who’s missing from the healthcare reform debate?
By Bruce Stanley Recently I attended a medical device symposium, where noted speakers
lectured on current technical topics. What I found astounding was that it took over four hours before anyone from the distinguished panel even uttered the word “patient.” This made me think a bit more about our national discussion about healthcare. We hear insurance choice or no choice, high deductible, low cost, high quality, medical device tax, exchanges, technology, contracting compliance, surcharge yes or no. Add this to the Washington, D.C., rhetoric of repeal, replace, skinny repeal. With the high-level political leaders, large manufacturers, lobbyists and other influential interests controlling the real destiny of healthcare, one must ask, “Do patients even matter anymore?” We’re told that healthcare is one-sixth of the economy, but never does
We never go to see a doctor and ponder why the medical device tax is so high. We go to be cared for and healed.
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Washington acknowledge that it involves 100 percent of the population. It’s been clear for awhile that healthcare is less about providing care for our citizens and more about health economics.
Circular debate only prolongs bad care This decade-long debate over the Affordable Care Act and the many proposed replacements only fuels the agonizing debate over what’s good for patients. It’s not always clear if healthcare thought leaders even believe it’s appropriate to bring up patients, let alone discuss how treatments should change. Does a patient or family member care if the system cost is $1 billion or $10 billion? Whether a device is taxed at 2.3 percent, 10 percent or zero percent? We
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TRENDS never go to see a doctor and ponder why the medical device tax is so high. We go to be cared for and healed. Products and services are often designed and developed based on a theory that they will contribute to better care. But has anyone asked patients for their opinions on the financial and clinical value of those products? We test for cost and function in the market, but often with little emphasis on patient understanding and satisfaction. Reimbursement is always an underlying theme. Current technological innovation is very promising, but it can’t replace one-on-one interactions. We need to
With the high-level political leaders, large manufacturers, lobbyists and other influential interests controlling the real destiny of healthcare, one must ask, “Do patients even matter anymore?”
remain connected with patients in a more meaningful way – not just by Twitter, Facebook and email. A veteran physician shared with me that when teaching new doctors, she must remind them to look at patients to assess their condition – not to just look at data on their computer screens. Today many entrepreneurs speak for the patient – but none of them are patients. That said, all of us – no matter what role we play – need to think and feel like patients
when designing products, developing strategies and holding discussions on healthcare reform.
How to get patients back into healthcare
Ask a patient what logistics, supply chain or contracting means for their care, and you might get a blank stare. Truth is, every part of our system can be patient-centric in a holistic way. Whether it’s a national group, an insurer, a governmental agency or product line company (the usual suspects), all can be instrumental in the national dialogue on healthcare. Most of all, the real leaders in healthcare are the day-to-day practitioners who must battle not only the disease states of their patients, but the constant barrage of innuendo, platitudes and pontificating from the many areas of our society weighing in on healthcare. Here’s a first step: Every time we invent or discover, implement, or just talk about healthcare, we ask how patients will feel about it. What will patients understand? How does this affect the care of patients? Clearly the future of personalized care using new care technologies may be on the horizon. Patient groups need to do their part to become more actively involved not only in the debate, but in actual product design and implementation. We should challenge everything we do in our industry. In this way, we might find stronger value statements with real purpose and ones that affect patients in a more meaningful way. Let’s start a robust dialogue around patient care, and begin designing new technology, payment schemes and long-term effective care always with the “Patient first.”
Bruce Stanley is a supply chain and contracting operations consultant, and an adjunct professor at Endicott College’s MBA program, teaching global supply chain, contracting and healthcare informatics and regulations. In 2011, he co-founded The Stanley East Consulting Group, in Ipswich, Mass., a consulting practice specializing in supply chain, contracting, order fulfillment and project management for small and medium-sized companies, startups, and companies in transition or divestiture. Earlier, he served as senior director, contracting operations, for Becton Dickinson.
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Eclypse is a high-capacity wound dressing designed to absorb and retain fluid, reducing the potential for leaks and minimizing the risk of maceration (that is, the breakdown of skin due to prolonged exposure to moisture). Eclypse has a rapid wicking face combined with a highly absorbent moisture locking system. The absorbent layer provides a large capacity with rapid fluid uptake. The bacteria- and viral-proof backing features a water-resistant barrier film to prevent strikethrough. And a high-moisture vapor transfer rate prolongs wear time. That’s important, because frequent dressing changes take up valuable time for the clinician and can be traumatic for the patient. Eclypse dressings can be used safely under compression without affecting their absorbency, and they absorb excess matrix metalloproteinases (MMPs) and other factors that can inhibit wound healing.
Hard-to-dress areas Traditionally, in order to treat hard-to-dress areas, clinicians have had to get creative and patch together dressings. But that’s timeconsuming. What’s more, such dressings may fail to provide the same level of wound management as a single, well-fit dressing.
• Eclypse Foot uses the high-fluidhandling capabilities of the Eclypse range in a preshaped dressing designed to fit comfortably and effectively around the foot. It is simple to apply and offers enhanced patient comfort. Eclypse Foot is particularly useful when treating a diabetic foot ulcer.
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• Eclypse Contour provides a new design, which will mold to the body contours, ensuring optimum contact with the wound and effective exudate management. Eclypse Contour reduces nursing time and cost, as the dressing doesn’t need to be changed as often as others. Most important, the patient trauma associated with a high frequency of change is reduced.
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Prepare your customers for USP <800> New standard for handling hazardous drugs goes into effect in December 2019 Beginning December 2019, hospitals, physicians’ of-
fices, home care agencies – in short, any healthcare setting in which hazardous drugs are handled – will be expected to comply with a new standard designed to minimize exposure to such drugs. The standard, USP <800>, was developed by the United States Pharmacopeial (USP) with the assistance of the U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention, Q: Who will be affected by <800>? A: <800> applies to all healthcare personnel who handle hazardous-drug (HD) preparations and all entities that store, prepare, transport or administer HDs (e.g., pharmacies, hospitals and other healthcare institutions, patient treatment clinics, physicians’ practice facilities, or veterinarians’ offices). Personnel who may potentially be exposed to HDs include, but are not limited to: pharmacists, pharmacy technicians, nurses, physicians, physician assistants, home healthcare workers, veterinarians, and veterinary technicians. Q: When must facilities comply with <800>? A: <800> is official and federally enforceable on December 2019. However, states or other regulatory agencies, accreditation organizations, and entity policy may require compliance before that date. This is all about limiting occupational exposure, so the sooner compliance is achieved, the safer the workplace will be. Q: What are the major differences between <800> and the 2008 version of USP <795> and <797>, which also addressed hazardous drugs? A: Two differences: • Scope: <795> and <797> deal with receipt, compounding, and storage up to the point of administration. <800> includes protection of healthcare workers from the time the HD is received, through and including administration of the HD and disposal of HD waste. •R equirement for use of closed system drug-transfer devices (CSTDs) when administering antineoplastic agents: CSTDs provide protection for those individuals who administer HDs and are required by <800> when the dosage form allows their use. Q: What is a closed system drug-transfer device? A: A CSTD mechanically prohibits the transfer of environmental contaminants into the system and the escape of hazardous drugs or vapor concentration outside of the system.
including the National Institute for Occupational Safety and Health, or NIOSH. Christopher Lomax, Pharm D., senior marketing manager, pharmacy advisor, B. Braun Medical Inc., recently took time to summarize information from “The Chapter <800> Answer Book” by Patricia C. Kienle about the importance of closed system drug-transfer devices. For more information on <800>, go to www.readyfor800.com. Q: Does <800> require the use of CSTDs for compounding HDs? A: <800> recommends the use of CSTDs for compounding, but it is not a requirement. Q: Does <800> require the use of CSTDs for administering HDs? A: Antineoplastics must be administered with a CSTD when the dosage form allows. Q: Can personnel use a CSTD instead of a hood for occasional HD compounding? A: No, a CSTD cannot be used as a substitute for the appropriate compounding facilities. It is a supplemental engineering control, not a primary engineering control (BioSafety Cabinet or Isolator Glove Box). Q: How can providers know if the CSTD they want to use actually works? A: They need to ask the CSTD supplier to provide independent testing results for its device. Q: Can nursing use a different CSTD for administration than one used in the pharmacy for compounding? A: That may be possible (depending on the CSTD components used), but it is probably not efficient. Nursing and pharmacy should work together to select the most appropriate product and components, to promote safety and efficiency, and to minimize the potential for removal of the device prior to use. Q: <800> says, “CSTDs known to be physically or chemically incompatible with a specific HD must not be used for that HD.” Can you elaborate on chemical incompatibility? A: In some situations, the components of a drug interact with the composition of the material used in certain CSTDs. For information on drug interactions, consult the product Instructions for Use (IFU) or the drug manufacturer’s labeling.
For more information on USP <800> and hazardous drugs, go to www.readyfor800.com 52
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B. Braun is proud to offer the OnGuard® CSTD (Closed System Transfer Device) to help healthcare institutions meet USP <800>1 requirements.
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HEALTHY REPS
Good for the heart? Good for the brain.
A long-term study suggests that middle-aged Ameri-
cans who have vascular health risk factors, including diabetes, high blood pressure and smoking, have a greater chance of suffering from dementia later in life. The study, published in JAMA Neurology, was funded by the National Institutes of Health (NIH). “This study supports the importance of controlling vascular risk factors like high blood
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pressure early in life in an effort to prevent dementia as we age,” said Walter J. Koroshetz, M.D., director of NIH’s National Institute of Neurological Disorders and Stroke (NINDS), which partially funded the study and created the Mind Your Risks® public health campaign to make people more aware of the link between cardiovascular and brain health. “What’s good for the heart is good for the brain.”
Sit up straight! Posture isn’t just about how you look. How you position yourself can help or hurt your health over your lifetime, according to the National Institutes of Health. How you hold yourself when you’re not moving – such as when you’re sitting, standing, or sleeping – is called static posture. Dynamic posture is how you position your body while you’re moving, like walking or bending over to pick something up. It’s important to consider both static and dynamic components of posture, says NIH. Keep in mind these methods to maintain posture: • Be mindful of your posture during everyday activities, like watching television, washing dishes or walking. •T ake frequent breaks for stretching and moving your body in different ways. • Stay active. • Maintain a healthy weight. •M ake sure work surfaces are at a comfortable height for you, whether you’re working in an office, doing a hobby, preparing dinner, or eating a meal. • Wear comfortable, low-heeled shoes.
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Diet and eye damage Near the center of the retina, at the back of the eye, is a small area known as the macula. It is needed for sharp, central vision, such as for seeing straight ahead to drive, read, and recognize faces. More than 2 million Americans have age-related macular degeneration (AMD). It’s a leading cause of vision loss among people aged 50 and older. Previous population studies have found that a high glycemic diet is associated with AMD onset and progress. Carbohydrates with a high glycemic load, such as white bread, can be quickly digested and so cause spikes in blood sugar. Carbohydrates with a low glycemic load, such as wholegrain bread, take longer to digest. With funding in part from the National Eye Institute, a team led by Drs. Allen Taylor and Sheldon Rowan of Tufts University explored the impact of dietary carbohydrates on retinal damage in mice, a sign of AMD. The team hypothesized that switching middle-aged mice from a high glycemic diet to a low glycemic diet would delay or stop retinal damage. In fact, mice fed a high glycemic diet developed signs of retinal damage. Although the retina of a mouse lacks a macula, these signs were similar to those in people with dry AMD. When the mice were switched from a high to low glycemic diet, the build-up of certain harmful metabolic factors in eye tissue was delayed, stopped, or even reversed.
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HEALTHY REPS Water bottles vs. kidney stones Can a high-tech water bottle help reduce the recurrence of kidney stones? What about a financial incentive? Those are questions researchers supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of NIH, will seek to answer as they begin recruiting participants for a two-year clinical trial at four sites across the country. Scientists will test whether using a smart water bottle that encourages people to drink more water, and therefore urinate, will reduce the recurrence of kidney stones. The randomized trial will enroll 1,642 people, half in an intervention group and half in a control group. The study’s primary aim is to determine whether a program of financial incentives, receiving advice from a health coach, and using a smart water bottle will result in reduced risk of kidney stone recurrence over a two-year period. The water bottle, called Hidrate Spark, monitors fluid consumption and connects to an app.
You’re in sales; you need your voice. So protect it. Identify and avoid behaviors that might harm your voice, cautions the National Institutes of Health.
Back to basics Skeptical of fad diets? The Washington Post lists five bits of practical advice that have stood the test of time, and probably will continue to do so for years ahead: 1) Choose a variety of foods (no one superfood can provide your body with the 40 nutrients it requires; 2) eat your vegetables (need we say more?); 3) get enough fiber (helps avoid constipation, reduces colon cancer risk, and can help prevent heart disease and Type 2 diabetes); 4) cut down on junk food (again, need we say more?); and 5) drink alcohol in moderation (ditto).
Pain management, 21st century style The U.S. Department of Health and Human Services, the U.S. Department of Defense, and the U.S. Department of Veterans Affairs announced a multi-component, $81 million, six-year research project focusing on nondrug approaches
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for pain management addressing the needs of service members and veterans. Approaches being studied include mindfulness/meditative interventions, movement interventions (e.g., structured exercise, tai chi, yoga), manual therapies (e.g., spinal manipulation, massage, acupuncture), psychological and behavioral interventions (e.g., cognitive behavioral therapy), integrative approaches that involve more than one intervention, and integrated models of multi-modal care.
A simple answer to ADHD? Educators, policymakers and scientists have referred to attention-deficit/hyperactivity disorder, or ADHD, as a national crisis and have spent billions of dollars looking into its cause, reports the Washington Post. But what if, as a growing number of researchers are proposing, many kids today simply aren’t getting the sleep they need, leading to challenging behaviors that mimic ADHD? Several studies have linked ADHD with the length, timing and quality of sleep. According to the newspaper, “In an era in which even toddlers know the words Netflix and Hulu, when demands for perfectionism extend to squirmy preschoolers and many elementary-age students juggle multiple extracurricular activities each day, one question is whether some kids are so stimulated or stressed that they are unable to sleep as much or as well as they should.”
Heading off asthma Got a baby in the house? Let him or her mix it up with some pets or pest allergens. That’s because a study published in September in the Journal of Allergy and Clinical Immunology reports that shows that infants exposed to high indoor levels of pet or pest allergens have a lower risk of developing asthma by 7 years of age. Previous studies have established that reducing allergen exposure in the home helps control established asthma, but the new findings suggest that exposure to certain allergens early in life, before asthma develops, may have a preventive effect.
The Velvet Fog You’re in sales; you need your voice. So protect it. Identify and avoid behaviors that might harm your voice, cautions the National Institutes of Health. For example, instead of speaking loudly when talking to a large group, arrange for a microphone. On days that your voice sounds raspy or hoarse, protect it by not straining or overusing it. Choose a quiet restaurant when meeting someone for a meal. Drinking plenty of water and using your voice less should help relieve hoarseness from misuse or overuse.
A Quick Sale. A Quality Product. The wide selection of products from Physio-Control can give you both. The right AED not only helps save lives but fits your customers’ needs for user guidance, CPR coaching, therapy delivery, durability and support. Ask your Physio-Control sales representative for more information about LIFEPAK® defibrillators and HeartSine® AEDs.
Physio-Control is now part of Stryker. For further information, please contact Physio-Control at 800.442.1142 or visit our website at www.physio-control.com ©2017 Physio-Control, Inc.
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.
Your car: A mind of its own Self-driving, or autonomous vehicles are about 10 years away How old are you? If you’re 50 or younger, and you in-
tend to remain in medical products sales, there’s a good chance you’ll be driving to your next sales call in (or being driven there by) an autonomous or self-driving vehicle. Backup cameras and adaptive cruise control technologies are already here, reports a new U.S. Department of Commerce Report, “The Employment Impact of Autonomous Vehicles.” The worldwide number of advanced driver-assistance systems (ADAS) – such as backup cameras and adaptive cruise control – increased
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from 90 million to 140 million units between 2014 and 2016. Consumers have indicated a willingness to pay $500 to $2,500 per vehicle for ADAS. Sensor technologies are rapidly advancing to provide sophisticated information to vehicle operating systems about the surrounding environment, such as road conditions and the location of other nearby vehicles, according to the Commerce Department report. Slower progress has been made in developing software that can mimic human driver decision-making, so that fully autonomous
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vehicles may not be introduced for another 10 or more years. But their arrival will change the sales rep’s day. The National Highway Traffic Safety Administration (NHTSA), part of the U.S. Department of Transportation, has a list of “Frequently Asked Questions” on its website. Here are a few.
Q: How safe are self-driving vehicles? A: No vehicle currently available for sale is “self-driving.” Every vehicle currently for sale in the United States requires the full attention of the driver at all times for safe operation. While an increasing number of vehicles now offer some automated safety features designed to assist the driver under specific conditions, there is no vehicle currently for sale that is fully automated or “self-driving.”
Q: What about hacking? A: Advanced vehicle safety technologies depend on an array of electronics, sensors, and computing power. In advancing these features and exploring the potential of fully autonomous vehicles, NHTSA is focused on cybersecurity to ensure that these systems work as intended.
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Q: Some concept automated vehicles lack a steering wheel, accelerator or brake pedal. Will I be able to drive my own vehicle in the future if it is automated? A: A vehicle that is fully automated will be capable of controlling all aspects of driving without human intervention, regardless of whether its design includes controls for a human driver. Companies may take different design approaches to fully “self-driving” vehicles that do or do not include controls allowing for a human driver. As is the case now, consumers will decide what types of vehicle designs best suit their needs.
Q: Will automated vehicles help the elderly and people with disabilities who cannot drive today? A: Some older Americans and people with disabilities are able to drive today by adapting or modifying their vehicles to meet their specific needs. Fully automated vehicles could offer new mobility options to many more people, helping them to live independently or to better connect them to jobs, education and training, and other opportunities.
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QUICK BYTES Editor’s note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, Repertoire will profile the latest developments in software and gadgets that reps can use for work and play.
Technology news
For those deep-dive sales calls
Drivin’ with the Colonel
Launched on Kickstarter in September, LunaR is a solarpowered smartwatch said to offer discreet notifications for text, calls and social media, as well as life-tracking and monitoring functionality, such as steps, distance, calories and sleep data. It offers dual time zone timekeeping, and is water-resistant up to 50 meters. Through a collaboration with Sunpartner Technologies, the transparent solar panel charges LunaR instantly when the watch is exposed to natural or artificial light. LunaR also alerts wearers when it’s time to get outside for some sunshine and a recharge.
Kentucky Fried Chicken® announced what it says is the world’s first-ever GPS cassette tape. What’s more, the cassette tape provides GPS directions with the voice of Colonel Harland Sanders himself, giving overly detailed directions, rambling down hilarious tangents and singing his favorite road trip sing-along songs. Beginning in KFC’s hometown, Louisville, Kentucky, and ending at KFC’s Big Chicken restaurant in Marietta, Georgia, KFC’s GPS cassette tape narrates a picturesque drive that recalls the trip Colonel Sanders took selling his fried chicken recipe door to door in the 1950s.
Docking station for new iPhones Enblue Technology launched EVOLUS 3 Qi, a multidocking station with wireless charging for the new iPhone 8 and iPhone X. It will charge iPad and Apple Watch as well. The EVOLUS 3Qi can host an iPhone and iPad of any size, and the Apple Watch series 1, 2, and 3. It will work with most cases on.
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Crystal clear OmniSpeech LLC said that its OmniClear™ technology is included in the latest Alcatel MOVE TIME smart watch. In addition to fitness tracking, email and SMS functionality, the watch enables users to make and receive phone calls directly from the device. OmniClear is speech extraction
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QUICK BYTES technology for mobile products, hearing aids, public safety digital radios and smart devices; it is said to recognize the speech signal and reduce everything that is not speech.
Working at Starbucks? Alcove Group was set to showcase its mobile workstation at TechCrunch Disrupt SF 2017. Alcove is a laptop case that unfolds into a private workspace, with privacy panels and an optional rechargeable backlight with a dimmer switch, said to support focused work and intimate collaborations in the noisiest environments.
Looking good Pose, from Opter, is a unisex necklace and clip that vibrates gently if you’re slouching to remind you to be confident and stand tall. Pose has a 7-plus-day battery life and other features that can be accessed through its companion smartphone app. UV sensing allows it to monitor time spent in the sun and blue light sensing allows it to recommend All of MySize’s different light levels for optechnology timal productivity and sleep. applications use In addition to basic fitness tracking with steps, exercise, the algorithms and sleep, Pose helps reduce of smartphone, sedentary time by intelligentrather than the ly reminding you to move if smartphone you’ve been still for too long.
camera, to record and document body measurements.
A close fit
My Size Inc. received its first patent for its Measure of a Body Part smartphone application for online clothing shoppers. The application is said to enable shoppers to always choose the right size garment on a retailer’s website using measurements taken with their smartphone of an area of their body. The application analyzes the recorded information using big data, and then recommends the appropriate size of the article of clothing the shopper has selected on a retailer’s website. All of MySize’s technology applications use the algorithms of smartphone, rather than the smartphone camera, to record and document body measurements. This maintains and ensures customer privacy, according to the company.
Fewer dead zones The weBoost Drive Sleek cellphone signal booster with adjustable cellphone holder is said to offer users outstanding
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call quality, fewer dead zones and faster data upload/download speeds while on the road. It uses coupling technology for reduced loss from outside antenna to improve 4G, LTE and 3G cellular signals up to 32 times, according to the company. The exterior antenna, which magnetically attaches to the vehicle’s roof, is said to reach out to cellphone towers to receive signal with voice, text and data, and transmit the signal to the booster.
Going to the chapel 24/7 You’ve had a hard day in the field, and you’d like a little spiritual sustenance. If you’re in Ellicott City, Maryland, no problem. The parish administrator of Our Lady of Perpetual Help installed a smartphone cloud-based access control solution, making the church’s Eucharistic Adoration Chapel a place where parishioners, community members and salespeople can pray 24/7. “One of the biggest benefits is the elimination of keys,” Lisa Sliker was quoted as saying. “We no longer needed to worry about keys being lost, stolen or shared.”
Hacker’s guide to the universe The Consumer Technology Association has published a guide to several frequently encountered types of cybercrimes that organizations should be equipped to spot and fight against. Some examples: • Ransomware: Software designed to hold a computer system or network hostage. • Hacking: Any intrusion or unauthorized entry into a computer, system or network. • Attacks: Attempts to disrupt operations or permanently disable them. • Phishing: A form of con in which others are tricked into inadvertently giving out information, typically by being fooled into mistaking a false source or contact for a legitimate one. • Identity theft: The practice of stealing another party’s identity for the purpose of making illegal transactions, registering or applying for services, causing harm to brand equity, gaining access to trade secrets, etc. • Denial-of-service attacks: Damaging cybercrime, which can cost a bundle of money to address and an average recovery time of 30 to 60 days. Human error is the single biggest vulnerability in security systems today, according to the association. To avoid falling prey to it, be a healthy skeptic, follow predetermined processes/procedures for validating identities, and ask a lot of questions.
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HIDA GOVERNMENT AFFAIRS UPDATE
HIDA Members and SNS Discuss
Preparedness During Streamlining Healthcare Conference
In September, more than 900 representatives from leading healthcare distributors,
By Linda Rouse O’Neill, Vice President, Government Affairs, HIDA
manufacturers, and group purchasing organizations came to Chicago for this year’s Streamlining Healthcare Conference. In addition to discussing leading industry issues, several participants joined representatives from the Strategic National Stockpile (SNS) to discuss emergency preparedness. This meeting is part of HIDA’s ongoing work with SNS to strengthen the healthcare supply chain, and make sure both federal and private sector leaders have an understanding of each other’s capabilities.
HIDA partners with SNS to strengthen public-private partnerships The purpose of the meeting was to continue the ongoing dialogue between the SNS and our industry to discuss various factors relating to public health emergency response. Topics covered included information-sharing capabilities, current and future processes and procedures, capacity and market availability of needed goods, and potential supply chain vulnerabilities during emergency events. During this discussion, SNS representatives and HIDA members outlined strategies for identifying weak points in the healthcare supply chain and detailed methods for gathering data from the commercial market to address these concerns. Participants then discussed how these moves would shape SNS decision-making during future public health crises.
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Key next steps in this collaboration include expanding industry participation in HIDA’s ongoing initiative with SNS. HIDA will reach out to leaders in other segments of the healthcare industry and will partner with both SNS and healthcare supply chain leaders to identify additional product groups (beyond gloves and needles) whose commercial data can be used to improve decisionmaking during a public health crisis.
HIDA members call on Congress to support public-private partnerships While HIDA members and SNS representatives had positive reports about their collaboration over the course of the year, federal emergency planners will not realize the full benefit of what the private sector has to offer without key legislative changes.
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Specifically, HIDA members ask that certain measures be included when the Pandemic and All-Hazards Preparedness Act (PAHPRA) comes up for reauthorization next year. Distribution leaders ask that PAHPRA Reauthorization direct resources from the Department of Health and Human Services through SNS to create a commercial “cushion” of key products for preparedness through a private-public partnership. Implementing a product inventory process that determines need, comprehends what the commercial market can support, and identifies gaps is necessary to ensure continuity.
• Develop an education and communications strategy to foster public-private collaboration. • Establish multi-year funding for emergency preparedness. • Set aside emergency/contingency funding, so Congress does not need to act every time there is a disaster. • Draw on work during the Ebola crisis, particularly hospital tiering, and permanently integrate this into disaster plans. • Improve coordination of re-entry with state and local authorities, so that distributors can carry pharmaceuticals and other goods across multiple jurisdictions.
During HIDA’s Washington Summit this summer, distribution leaders outlined the following policy principles that can help the federal government make the most of industry experience: • Identify key products and understand market capacity to supply these. • Vet medical products on key criteria and determine the best solution to ensure ample supply during a public health crisis.
While members communicated these needs during this year’s Washington Summit, it is still important that lawmakers are aware of them as the government responds to the hurricanes in Texas, Florida, and Puerto Rico, and as Congress makes budget plans. Do not hesitate to reach out to your elected representatives and share the ways you or your company’s expertise could help during a public health emergency. Feel free to contact us at HIDAGovAffairs@HIDA.org if you have any questions or would like more information.
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SMART SELLING
DISTRIBUTOR SALES STRATEGIES FROM HIDA
Use Social Media to Reach Beyond Your Base In a previous column, I noted that many of us in the business world use LinkedIn every
By Elizabeth Hilla, Senior Vice President, HIDA
day to find information about the people and companies with which we work. I pointed out that your customers do this too, so maintaining a professional, customer-focused profile can enhance your sales success. I stand by that advice, but it’s purely passive – you’re just ensuring that your profile makes you attractive to the customers who look you up. Now, I’m advising you to take the next step and actively use social media to bring in new business and new customers. If you know me, you’re probably laughing. I’m the last person to endorse social media – the photos on my Facebook page haven’t changed since maybe 2008. But lately, I’ve seen the power of social media, particularly LinkedIn, for reaching prospects, and I think sales reps can embrace this opportunity in a big way. But wait, you say, my company’s marketing department has a great social media presence. If that’s true, fantastic! You can build on it, and make it more personal and therefore more effective.
Or maybe you say: no way, my company doesn’t do much social media marketing. That’s okay too – it’s easier than you think to build business by doing your own posts. I’m a newbie to this, but I’ve been experimenting lately, and also reading lots of social media articles and posts from other people. Here are some ideas based on my personal preferences and experiences, but I encourage
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you to investigate for yourself as well. I’ll start with what’s simple and progress from there.
Sharing and liking content from others The easiest first step in social media is to selectively “like” posts from others. Be sincere – “like” things that genuinely appeal to you, but also consider what would be of
interest to your target audiences. Look for appropriate opportunities to “like” your customers’ and vendors’ posts. Even more selectively, “share” posts from others. Adding your own short message will explain to others why you’re sharing the article or post. At a minimum, share items posted by your own company’s marketing department, and from your key vendors. By sharing these, you’ll give them a wider audience, and you’ll also connect yourself personally to the message. You also may want to share such items as: • I tems on topics of interest to your customers and prospects, such as new research on infections or data on readmissions •A n occasional fun or motivational post (I recommend choosing carefully and doing this sparingly).
Creating original content Creating your own posts is also easy, and it can be very effective. What you post depends on what you want to achieve, and on your own personality. If you’re outgoing with a big persona, posting the occasional enthusiastic, let’s-make-it-a-great-day kind of posts may fit for you. If you’re very social, you may enjoy posting photos of yourself with business associates or customers. And if you’re an all-business kind of person, you may stick to factual updates. Any of these can potentially advance your business. Here are some ideas I’ve seen that you might want to try, separately or in combination, along with some examples I took straight from some of my contacts’ LinkedIn posts: •S hare an idea, statistic, or news item that customers can act on: “What are the steps for accurate BP measurement? Check your methods with these quick reminders…” (Kurt Forsthoefel, Midmark) •S hare a personal experience or comment: “I love the who, the what and the how about my job. Having the opportunity to work with healthcare manufacturers, distributors and providers to improve their supply chain processes is incredibly rewarding to me.” (Denise Odenkirk, GHX) • Tie your message to a key customer issue or need: “Every hospital is seeking new ways to improve the patient experience. As a commercial laundry, you can help your hospitals protect patient modesty through safe and comfortable patient apparel solutions...” (Joe Przepiorka, Encompass)
Try to include some kind of visual with your post. I personally like real-life photos (Repertoire publisher Scott Adams does this very well so check him out on LinkedIn for good examples). You can also use a stock photo or graphic: scroll through your news feed and you’ll see hundreds of ideas. Include a hyperlink for readers to get more details, if that’s appropriate.
Use social media to multiply the effectiveness of other channels Social media posts can expand visibility for other marketing efforts, such as webinars, trade shows, and blog posts. For example, many people invest thousands in trade shows, only to be disappointed with their booth traffic. LinkedIn posts are a great way to build traffic beforehand, and to extend your message during and after the shows you attend. You can post an invitation to visit your booth well before the event date, and again with an update during the event. A photo of your smiling booth personnel makes it personal.
Posting or sharing relevant content can show customers and prospects your areas of expertise and enhance your position as a trusted advisor.
Try it If you’re thinking to yourself: “no kidding, I’ve used social media for years and these tips are obvious” – congratulations! Keep up the good work. If on the other hand, you’re thinking “I’m too old (too busy, whatever) to spend time on social media,” I encourage you to put your toe in the water and give it a try: • An interesting message can get shared far beyond your “first degree” network, exposing you to many new prospects. • Adding a personal touch can help you make personal connections • Posting or sharing relevant content can show customers and prospects your areas of expertise and enhance your position as a trusted advisor. Good luck and smart selling!
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corner
Parts Unknown Iowa-born and bred, Brandon Young calls on an even vaster expanse today
and physically. Also, she thought I could excel at it. That’s why he got into wrestling. And the effect? Some life lessons learned. “In wrestling, there is no one to fault but yourself. You can’t blame anyone else for a loss except yourself – which makes wins much more satisfying. Every day the sport expands your comfort zone and makes you mentally tougher. In my opinion, there is no other sport that can do this to that extreme.” A perfect mindset for a medical products salesperson, especially one who covers a state bigger – and more mountainous – than many countries.
North Liberty
Cause and effect. There’s something to it.
“I was a pretty tough kid from having an older – and much bigger – brother, and growing up on a farm,” says Brandon Young, Alaska-based field sales consultant for Henry Schein. So, for Christmas in fifth grade, his mother gave him a wrestling singlet and signed him up for the Wild West wrestling club in eastern Iowa. “My uncles and grandfather on my mom’s side were really good at it, so it was natural to get me into the sport,” he says. “Plus, I am sure I had too much energy, and was horrific at basketball. “As I got into middle school and high school, I understand why my mom got me into the sport,” he says. “As a single mom, she wanted me to be challenged mentally
“People really appreciate it when you go out to see them in Bethel.”
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Young was born and raised on a small family farm in North Liberty, Iowa, just north of Iowa City. His mother, Margaret Young – like her mother before her – is a nurse. For most of her career, she practiced nursing at the University of Iowa Hospitals and Clinics and Mercy Hospital in Iowa City. Today, she is a traveling nurse, taking on assignments across the Western states. His father, Mike Young, is the owner/operator of a small trucking company, hauling grain from local farms to the elevator. Young himself attended Loras College in Dubuque, Iowa. “It has a great reputation for academics, was fairly close to home, and allowed me to have a balanced college life,” he says. “I could wrestle, work and enjoy off-campus activities.” Throughout high school and in college, Young worked on and off at Heartland Medical in Iowa City, helping with setups and other tasks. Heartland was founded by Doug and Brian Rummelhart. They – and a third partner, Ted Pacha – had run Hawkeye Medical prior to that company’s acquisition by McKesson Medical-Surgical in 2001.
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corner River, Alaska, just outside of Anchorage. (Her mom was a native of Fort Dodge, Iowa.) Karrie is an advanced practice registered nurse. “I asked her if she wanted to move back to Alaska, and she said, ‘Absolutely.’” Having lived all his life in Iowa, Young himself was ready for a move. Stretching more than 660,000 square miles, Alaska is about two and a half times larger than Texas. It’s the kind of place where a sales rep not only needs a car, but access to small aircraft – when weather permits – to call on accounts. Despite its vastness, though, Alaskans take quickly to “locals,” even if those locals live 500 miles away. “If you have a 907 number, you’re kind of in the club,” he says. He tries to call on his rural customers four to five times a year, planning his routes judiciously. “People really appreciate it when you go out to see them in Bethel,” he says. Between times, he’s on the phone. And he has plenty of help. “At Henry Schein, our motto is Team Schein,” he says. Bethel to Barrow “We have a team behind us.” One of his teammates is customer In 2009, Young made a big move. An opportunity opened service rep Margie Main. “She is my inside telesales partner in up in Alaska. Turns out his wife, Karrie, whom he had met about half my accounts. She is super knowledgeable, and our when she attended the University of Iowa, was from Eagle drive is very similar.” Together they won the unified sales team award in 2016. Young occasionally goes hunting and fishing with customers, as well as relatives. But he still tries to make one or two Iowa Hawkeyes football games a year. “I do miss the corn fields like crazy,” he adds. He still loves wrestling, and when time allows, volunteers at Eagle River High School and the Chugach Wrestling Club, a club that is open to all wrestlers age 5 and up. And he continues to carry with him the lessons he learned while wrestling in Iowa. “The sport of wrestling has a lot of similarities to my career,” he says. “You are part of a team, but you have individual goals.” Wrestling teaches that you can learn from your mistakes, he says. It teaches tolerance to a heavy workload, how to adjust in a competitive atmosphere, the satisfaction of winning and the humility of losing, and mostly, motivation. “Not only extrinsic motivation – competitors in the field, compensation, company incentives – but intrinsic motivation. “That’s the wrestling mentality, the athletic mentality. You’re not always motivated by outside influences. A lot of times you’re motivated by yourself and what you feel your personal goals are.” Karrie and Brandon Young have three children: Reagan, Mason and Hattie. “These guys were very well respected in the Iowa City area, and I always admired them,” says Young. And he liked what he saw at Heartland. “The sales reps seemed to enjoy what they did and got to interact with a lot of people.” So, when Doug Rummelhart offered him a job after graduation, Young gladly accepted. “Not many companies are willing to give a chance to a young, 21-22-year-old kid, and take him under their wing. But they did.” He spent about a year in the warehouse and customer service before going into the field in eastern Iowa. “At the time, I was a little frustrated, because I wanted to be in the field. However, in hindsight, it was the best training. “Even though I’m only in my early 30s, I feel like I am among the last generation to come from a mom-and-pop distributor.” (Heartland was acquired by Henry Schein in 2008.)
“In wrestling, you can’t blame anyone else for a loss except yourself – which makes wins much more satisfying.”
70
November 2017
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Uncontrolled Hypertension 58.1% in 2011–2014. Among women with hypertension, the age-adjusted percentage with uncontrolled high blood pressure declined from 68.5% in 1988–1994 to 45.5% in 2011– 2014. However, for women, the magnitude of the decline changed over this period. During 1988–1994 through 2011– 2014, among those with hypertension, the age-adjusted percentage of uncontrolled hypertension was higher for men than for women.
Duringin1988–1994 through 2011–2014, the age-adjusted 58.1% 2011–2014. Among women with hypertension, percentage of uncontrolled high blood pressure among adults the age-adjusted percentage with uncontrolled high blood aged 20 and over with decreasedtofor45.5% all adults and pressure declined fromhypertension 68.5% in 1988–1994 in 2011– for men and women separately; in 2011–2014, the prevalence 2014. However, for women, the magnitude of the decline of uncontrolled pressure men and women with changed overhigh thisblood period. Duringamong 1988–1994 through 2011– 2014, among varied those with hypertension, the age-adjusted hypertension by age. percentage of uncontrolled hypertension was higher for men Hypertension is an important risk factor for cardiovascular than for women. disease, stroke, kidney failure, and other health conditions (57,58) and canthe lead to premature death (59,60). Inhigh 2011– In 2011–2014, pattern by age for uncontrolled 2014, 84.1% of adults hypertension were aware of their blood pressure amongwith those with hypertension differed status, and were taking medication lower their the among men76.1% and women. Among men withtohypertension, blood pressure (61). prevalence of uncontrolled high blood pressure was higher for those in the two youngest age groups than for those of During 1988–1994 2011–2014, the age-adjusted other ages. Among through women with hypertension, the prevalence percentage of adults aged 20 was and higher over with of uncontrolled hypertension for hypertension women aged who had uncontrolled high blood pressure decreased steadily 75 and over than for women aged 35–44, 45–64, and 65–74 from 77.2% to 52.8%. of Among men with hypertension, years; the prevalence uncontrolled hypertension wasthe not age-adjusteddifferent percentage with uncontrolled high and blood significantly for women in the youngest oldest pressure decreased steadily from 83.2% in 1988–1994 to age groups.
During 1988–1994 through 2011–2014, the age-adjusted percentage of uncontrolled high blood pressure among adults aged 20 and over with hypertension decreased for all adults and for men and women separately; in 2011–2014, the prevalence of uncontrolled high blood pressure among men and women with hypertension varied by age.
TRENDS
Hypertension is an important risk factor for cardiovascular disease, stroke, kidney failure, and other health conditions (57,58) and can lead to premature death (59,60). In 2011– 2014, 84.1% of adults with hypertension were aware of their status, and 76.1% were taking medication to lower their blood pressure (61).
In 2011–2014, the pattern by age for uncontrolled high blood pressure among those with hypertension differed among men and women. Among men with hypertension, the prevalence of uncontrolled high blood pressure was higher for those in the two youngest age groups than for those of other ages. Among women with hypertension, the prevalence of uncontrolled hypertension was higher for women aged 75 and over than for women aged 35–44, 45–64, and 65–74 years; the prevalence of uncontrolled hypertension was not significantly different for women in the youngest and oldest age groups.
U.S. Healthcare at a Glance During 1988–1994 through 2011–2014, the age-adjusted percentage of adults aged 20 and over with hypertension who had uncontrolled high blood pressure decreased steadily from 77.2% to 52.8%. Among men with hypertension, the age-adjusted percentage with uncontrolled high blood pressure decreased steadily from 83.2% in 1988–1994 to Figure 14. Uncontrolled high blood pressure among adults aged 20 and over with hypertension, by sex
Health, United States, 2016 is the
and age: States, 1988–1994 through 2011–2014 Figure 14.United Uncontrolled high blood pressure among adults aged 20 and over with hypertension, by sex and age:
Percent
Percent (age-adjusted)
Percent (age-adjusted) Percent
Figure 14. Uncontrolled high blood pressure among adults aged 20 and over with hypertension, by sex and age: 40th report on the health status of United States, 1988–1994 through 2011–2014 United States, 1988–1994 through 2011–2014 100 100 the 100nation and is compiled by the 100 2011–2014 2011–2014 Centers for Disease Control and Pre20–34 65–74 35–44 45–64 75 and over 90 90 20–34 65–74 35–44 45–64 75 and over 90 90 Utilization Utilization Men Men vention’s (CDC) National Center for Prescription Drugs Prescription Drugs 80 80 Total 80 80 74.1 Health Total Statistics (NCHS). 74.1 increased throughout period, adults In 2013–2014, 36.5% of adults aged 18–44, 69.6% of adults aged In 70 70 Women throughout the period, while for adults aged 18–44 2013–2014, 36.5% of the adults agedwhile 18–44,for 69.6% of aged adults18–44 aged increased Women 70 70 and 65 and over, use initially increased before remaining The Health, 45–64, and 90.8% of those United aged 65 andStates over took aseries prescription 64.2use initially increased before remaining and 65 and over, 45–64, and 90.8% of those aged 65 and over took a prescription 64.2 stable in recent years. For adults aged 18–44, use of at least drug in the past month—up from levels in 1988–1994. stable in recent years. For adults aged 18–44, use of at 61.5 least 61.5 drug in the past month—up from levels in 1988–1994. 60 60 one prescription drug remained stable from 2007–2008 to presents an annual overview of na60 60 one prescription drug remained stable from 2007–2008 to 55.5 55.5 over, use of at least 2013–2014, while for adults aged 65 and Prescription drug use over the past 40 years has been affected Prescription drug use over the past 40 years has been affected 2013–2014, while for adults aged 65 and over, use of at least 49.7 onemany prescription drug stable from 2003–2004 to by many factors, including medicalstatistics. need, prescription drug tional trends in health The 49.7 remained one50 prescription drug remained stable from 2003–2004 to by factors, including medical need, prescription drug 50 46.5 50 50 2013–2014. development, increased direct-to-consumer advertising, 46.5 2013–2014. development, increased direct-to-consumer advertising, 44.5 44.5 and expansions in health and prescription drug report contains a insurance Chartbook that asand expansions in health insurance and prescription drug 38.2 Between 1988–1994 and 2013–2014, the percent ofliving adults coverage (62–64). Even though Americans are now living 40 40 37.7 38.2 36.8 Between 1988–1994 and 2013–2014, the percent of adults coverage (62–64). Even though Americans are now 40 40 37.7 36.8 reporting thea use of five or more prescription drugs the longer lives, greater fraction of older Americans are living sesses theanation’s health by presentreporting the use of five or more prescription drugs in the longer lives, greater fraction of older Americans areinliving past 30 days rose—by 2.7 percentage points for adults aged with several chronic conditions that may require multiple past3030 days rose—by 2.7 percentage points for adults aged with30several chronic conditions that may require multiple 18–44, points for adults aged 45–64, and 28.4 18–44, As prescription drug use increases, however, 30 12.8 percentage 30 ingmedications. trends and current information on 12.8 percentage points for adults aged 45–64, and 28.4 medications. As prescription drug use increases, however, percentage points for polypharmacy. adults aged 65 and over. In contrast, so do concerns about polypharmacy. Polypharmacy— percentage points for adults aged 65 and over. In contrast, so do concerns about Polypharmacy— the 20 percentage of adults reporting thefive useorofmore one to four which is commonly defined as taking five or moremordrugs— selected measures of morbidity, the20 percentage of adults reporting the use of one to four which is commonly defined as taking drugs— 20 20 prescription these twoadverse periods drug remained increases the risk of drug interactions, adverse drug events, prescription drugs between these two periods remained increases thedrugs risk ofbetween drug interactions, events, stable for adultsand aged 18–44 functional and 45–64,capacity while decreasing for nonadherence, and reduced functional and capacity (65). tality, healthcare utilization access, stable nonadherence, reduced (65). 10 for adults aged 18–44 and 45–64, while decreasing for 10 adults aged 65 and over. 10 10 adults aged 65 and over. Between 1988–1994 and 2013–2014, the use of at least health risk factors, prevention, health Between 1988–1994 and 2013–2014, the use of at least one prescription drug in the past 30 days increased 5.2 0 0 one 0prescription drug in the past 30 days increased 5.2 0 percentage points for adults aged 18–44, 14.8 percentage 1988–points for adults1999– 2003– 2007– 2011– Men Women aged 18–44, 14.8 percentage insurance, and personal healthcare ex1999– 2003– 2007– 2011– percentage Men Women 1994 2002 2006 2010 2014 points1988– for adults aged 45–64, and 17.2 percentage points 1994 2002 2006 2010 2014 points for adults aged 45–64, and 17.2 percentage points for adults aged 65 and over. For adults aged 45–64, use for adults aged 65 and over. For adults aged 45–64, use penditures. This year’s Chartbook foof at least one prescription drug during the past 30 days of at least one prescription drug during the past 30 days Utilization cuses on long-term trends in health. Health Provider Visits Figure 15. Prescription drug in the past 30 years among adults aged 18 and over, by age and number Figure 15. Prescription drug use in the past 30 days among adults aged 18Prescription and over, bydrug age anduse number of30 drugs Figure 15. use in the past daystaken: among adults aged 18 and over, by age and number of drugs taken: The complete report and related data Excel and PowerPoint: http://www.cdc.gov/nchs/hus/contents2016.htm#fig14 of drugs taken: United States, United States, 1988–1994 through 2013–2014 Excel and PowerPoint: http://www.cdc.gov/nchs/hus/contents2016.htm#fig14 United States, 1988–1994 through1988–1994 2013–2014 through 2013–2014 of persons with a mental health provider visit was lower than Between 1997 and 2015, the percent of persons with a health Utilization Utilization Utilization products are available on the Health, 100 for any other type of provider; in 2015, 8.7% children, 100 care visit in the past 12Use months increased for each of five Prescription drug use in the pastof 30 days, of at least one prescription drugprovider that24 Prescription drug use in theHealth, past 30 days,States, 2016 of at least one drug Chartbook onUse Long-term Trends inprescription Health United 90.8 24 among Chartbook on Long-term in65 Health Health, United States, 2016 8.8% of adults aged 18–64, and 4.8% ofVisits those 65 and over Health Health Provider Health Provider Visits Provider Visits by age andpast number of drugs taken in theTrends past days, ageAmong types children andwebsite adults aged30 andby over. 90.8 by age and number of drugs taken in the 30 days, by age United States at: www.cdc. reported a visit to a mental health provider in the past year. adults aged 18–64, the percent with a visit to a dentist remained At least one drug At least oneprovider years and over stable and the65percent with a visit to the other four provider of apersons persons aof mental persons with health a mental with adrug mental healthvisit provider health wasprovider lower visit was than visit lower wasthan lower than Between 1997 Between and 2015, 1997 and the 1997 percent 2015, and the 2015, ofpercent persons the percent of with persons a health persons with a health with healthofwith gov/nchs/hus.htm. 65Between years over Among all three groups, the percent with aof health care 1–4 age drugs 80 types increased. NOTES: Uncontrolled high blood pressure among persons with hypertension is defined SOURCE: NCHS, National Health and Nutrition Examination Survey (NHANES). as measured systolic pressure of at least 140 mm Hg or diastolic pressure of at least 90 mm Hg, among those with measured high blood pressure or reporting taking antihypertensive medication. Estimates for the left figure are age-adjusted. See data table for Figure 14.
NOTES: Uncontrolled high blood pressure among persons with hypertension is defined as measured systolic pressure of at least 140 mm Hg or diastolic pressure of at least 90 mm Hg, among those with measured high blood pressure or reporting taking antihypertensive medication. Estimates for the left figure are age-adjusted. See data table for Figure 14.
SOURCE: NCHS, National Health and Nutrition Examination Survey (NHANES).
that any that other forthat any type for other ofany provider; type other of type in provider; 2015, of provider; 8.7% in 2015, of children, in8.7% 2015, of8.7% children, of children, 1–4 drugs care visit80 incare thevisit past care in12the visit months past in the 12 increased past months 12 months increased for eachincreased offor five each provider for of each five provider of fivefor provider 73.6 visit in the past year increased overall between 1997 and 5+ drugs 73.6 of adults 8.8% aged of8.8% adults 18–64, aged adults and 18–64, aged 4.8% and of 18–64, those 4.8% and 65 of4.8% and those over of65 those and over 65 and over types among children among among children adults children and aged adults 65 and and aged adults over. 65aged Among and over. 65 and Among over.8.8% Among 5+ofdrugs 69.6 2015 fortypes each oftypes theand provider types shown with the exception reported areported visit toreported aamental visit toahealth avisit mental toprovider a mental healthin provider health the69.6 past provider inyear. the past in the year. past year. adults aged adults 18–64, aged adults the18–64, percent agedthe 18–64, with percent athe visitpercent with to aadentist visit withtoaremained avisit dentist to a remained dentist remained of dental visits among adults aged 18–64, which remained 48.7 48.7 stable andstable the percent stable the with and percent athe visitpercent with to the a visit other withtoafour visitother provider to the four other provider four provider stable. After a and decrease in the percent ofthe adults aged 18–64 Among all Among three age Among all three groups, all age three the groups, percent age groups, the with percent the a health percent with care a health with a care health care types increased. types45–64 increased. typesyears increased. with a dental visit between 1997 and 2006 (from 64.1% to visit in the visit past in year the visit past increased in the year past increased overall year increased between overall 1997 between overall and between 1997 and 1997 and 54.8 60 54.8 2015offor each 2015offor the 2015 each provider for ofeach thetypes provider of the shown provider types with shown types the exception with shown thewith exception the exception 62.4%), the percent increased toare 64.0% Visits to health Visits providers toVisits health toproviders are health influenced providers influenced byare abetween variety influenced byof a2006 variety factors by and a of variety factors factors ofofdentalof visits of dental among of visits dental adults among visits aged among adults 18–64, aged adults which 18–64, aged remained which 18–64,remained which remained 2015. including including patientincluding characteristics, patient patient characteristics, supply characteristics, and supply distribution and supply distribution of and distribution stable. a decrease After stable. a in decrease After theapercent decrease in theofpercent in adults the percent aged of adults 18–64 ofaged adults 18–64 aged 18–64 providers,providers, and health providers, and care health affordability. andcare health affordability. care Since affordability. the Since 1990s,the shifts Since 1990s, thestable. shifts 1990s,After shifts 49.4 59.9 49.4 59.9 with a dental withvisit a dental with between a visit dental 1997 between visit and between 1997 2006 and (from 1997 2006 64.1% and (from 2006 to 64.1% (from to 64.1% to in diseaseinprevalence disease in disease prevalence have increased prevalence have increased the have need increased for thechronic need the forneed chronic for chronic 36.5 62.4%), the 62.4%), percent 62.4%), the increased percent the percent increased to 64.0% increased between to 64.0% to 2006 between 64.0% and between 2006 and 2006 and care management, care while management, expansions while expansions while to health expansions insurance to health toinsurance health insurance 36.5 40care management, 2015. 2015. 2015. 18–44 years coverage coverage have rendered coverage have rendered health have services rendered healthmore services health affordable services more affordable for more affordable for for 31.3 47.5 31.3 47.5 those previously those previously those uninsured previously uninsured (66,67).uninsured Increases (66,67).(66,67). Increases in the supply Increases in the supply in the supply of selected ofprovider selected of selected types provider have provider types also have increased types also have increased thealso potential increased the potential the potential for utilization, for utilization, although for utilization, although geographic although geographic differences geographic differences in thedifferences in the in the 42.2 32.6 42.2 In 1997, 202006, and 2015, the percent of persons with one 32.6 distribution of providers distribution of providers may of create providers may disparities create maydisparities create in utilization disparities in utilization in utilization 20distribution 30.1 or more visits to generalist physicians in the past year was by urban/rural by urban/rural status by urban/rural (68,69). status (68,69). status (68,69). 30.1 higher than the percent with visits to specialist physicians, 20.2 20.2 2006, In 1997, and In2006, 2015, 1997,and the 2006, 2015, percent andthe 2015, ofpercent persons the percent ofwith persons one of persons with with one eye doctors, or mental health providers among children aged In 1997,1.2 13.8 one 13.8 1.2 7.4 or more to generalist orvisits more generalist physicians to generalist physicians in the physicians pastinyear the past was in the year past was year was 2–17, adults aged 18–64, and adults 65 and over. The percent or more visits 3.9tovisits 7.4 3.9 higher than higher the percent than higher thethan with percent the visits percent with to specialist visits with tovisits specialist physicians, to specialist physicians, physicians, 1988– 2013– 1988– 2013– 1988– 2013– eye doctors, eyeor doctors, mental eye2014 doctors, or health mental or providers mental health among health children amongaged among children aged aged 1988– 1999– 2013– 1988– 2013– 1988– 2013– 1988– 2013– 1994 1994providers 2014providers 1994 children 2014 1988– 1999– 2013– 1994 2000 2014 1994 2014 1994 2014 1994 2014 2–17, adults 2–17, aged adults 2–17, 18–64, aged adults and 18–64, aged adults 18–64, 65 adults andand over. 65 adults and The percent over. 65 and The over. percent The percent 2000and Figure 16. Health care visits in the past 12 months among children aged 1994 2–17 and adults aged 18 and over, by age and and 2014 18–44 years 45–64 years 65 years over 18–44 years 45–64 years 65 years and over provider type: United States, 1997, 2006, and 2015
Visits to health providers are influenced by a variety of factors including patient characteristics, supply and distribution of 45–64 years providers, and health care affordability. Since the 1990s, shifts 60 prevalence have increased the need for chronic in disease care management, while expansions to health insurance coverage have rendered health services more affordable for those previously uninsured (66,67). Increases in the supply of selected provider types have also increased the potential 40 for utilization, although 18–44 years geographic differences in the distribution of providers may create disparities in utilization by urban/rural status (68,69).
NOTES: Respondent-reported use of prescription drugs in the past 30 days. See Appendix II, Drug. See data table for Figure 15.
Percent
Percent
Here are several charts to share with your customers, from Health, United States, 2016 [www.cdc.gov/nchs/data/ hus/hus16.pdf#listtables]
SOURCE: NCHS, National Health and Nutrition Examination Survey (NHANES).
NOTES: Respondent-reported prescription drugs the past 3012 days. See SOURCE: NCHS, National Health Nutrition Examination Survey Figure 16.Figure Health16. Figure care Health visits 16. use Health care inofthe visits care past invisits 12 the months past ininthe 12among past months children months among among aged children 2–17 children aged and 2–17 adults aged and 2–17 aged adults and 18 and and aged adults over, 18aged and by age 18 over, and and by over, age(NHANES). by andage and Appendix II, Drug. See data table for Figure 15. 65 years and and over 18–64 years provider type: provider United provider type: States, United type: 1997, United States, 2006, States, 1997, and2006, 1997, 2015 2006, 2015 and 2015
2–17 years
Excel and PowerPoint: http://www.cdc.gov/nchs/hus/contents2016.htm#fig15 77.5
Excel and63.3 PowerPoint: http://www.cdc.gov/nchs/hus/contents2016.htm#fig15 82.2 2–17 years 18–64 years 2–17 years2–17 years 18–64 years 18–64 years
Figure 16. Health care visits in the past 79.6 12 months Generalist 83.8 among childrenonaged 2–17 andinadults aged 18 25 Chartbook Long-term Trends Health and over, by age and provider type: United States, 20.9 1997, 2006, and11.9 2015 Specialist
19.6 23.0 27.8 1997
6.7 7.0 8.8
2006 2015
1997
0
20
40
60
80
Percent with 1 or more visits
100
27.8
2006 6.3
39.5 45.5 46.8
11.9 13.1 14.2
64.1 62.4Dentist Dentist 64.0
Dentist
0
20
27.8
2.2
6.3 6.3 Mental health Mental health Mental health 3.7 2015 6.0 4.86.0 6.0 provider provider provider 8.7 8.7 8.7
72.7 75.7 84.7
Dentist
72
11.9 11.9 Specialist Specialist Specialist13.1 13.1 14.2 14.2
51.8 57.1 58.5
31.2 31.8 19.6 19.6 19.6 36.2 23.0 Eye doctorEye doctor Eye 23.0 doctor 23.0
6.3 6.0 8.7
Mental health provider
85.2
63.3 62.2 65.1
77.5 United 77.5States, 77.5 87.9 2016 Health, 25 Chartbook on Long-term Trends in79.6 Health 79.6 79.6 Generalist Generalist Generalist 83.8 83.8 83.8
22.0 23.2
13.1 14.2
Eye doctor
62.2 65.1
40
60
27.8 1997 2006 2015
20.9 22.0 23.2
1997
31.2 31.8 36.2
1997
1997 2006 6.7 2006 6.7 2006 7.02015 7.0 2015 8.8 2015 8.8
54.8
72.7 72.7 72.7 58.0 75.7 75.7 75.7 62.7 84.7 84.7 84.7
60 0 400200 6020 40 20 80 40 60 40 10080 600 0 80 20 100
63.3 62.2 65.1
65 years and years overand over 65 years and over 65
63.3 62.2 65.1
82.2 82.2 82.2 Health, United States, 2016 85.2 85.2 85.2 87.9 87.9 87.9 39.5 45.5 46.8
20.9 22.0 23.2
20.9 22.0 23.2
51.8 57.1 58.5
31.2 31.2 31.8 31.8 36.2 36.2 6.7 7.0 8.8
1997 2006 2015
64.1 62.4 64.0
39.5 39.5 45.5 45.5 46.8 46.8
1997 1997 2006 2.22006 3.7 2015 2015 4.8 64.1 62.4 64.0
64.1 62.4 64.0
80 100 20 80 60 40 10080 600 20 0 100 40 200 60 40 100 80
2.2 3.7 4.8
2.2 3.7 4.8 54.8 58.0 62.7
51.8 51.8 57.1 57.1 58.5 58.5 1997
1997
1997
2006
2006
2006
2015
2015
2015
54.8 54.8 58.0 58.0 62.7 62.7
100 8020 0 100 20 80 60 40 10080 60 40 200 60 40
100 80
100
Percent with 1 or more visits with 11 or more visits with Percent Percent 1 or more with visits 1 orwith more visits Percent with Percent 1 or more Percent with visits 1 orwith more 1 or visits more visits Percent 1 or more visits Percent with 1 orPercent more Percent with or more visits Percent with visits 1 or more visits
NOTE: See data table for Figure 16.
NOTE: See data NOTE: table See for NOTE: data Figure table See 16. data for Figure table 16. for Figure(NHIS). 16. SOURCE: NCHS, National Health Interview Survey
Excel and PowerPoint: http://www.cdc.gov/nchs/hus/contents2016.htm#fig16
Excel and PowerPoint: Excel and Excel http://www.cdc.gov/nchs/hus/contents2016.htm#fig16 PowerPoint: and PowerPoint: http://www.cdc.gov/nchs/hus/contents2016.htm#fig16 http://www.cdc.gov/nchs/hus/contents2016.htm#fig16
26 November • www.repertoiremag.com 26 Chartbook2017 on Long-term Trends in Health
SOURCE: NCHS, SOURCE: National NCHS, SOURCE: Health National Interview NCHS,Health National Survey Interview Health (NHIS).Survey Interview (NHIS). Survey (NHIS).
Chartbook 26 Chartbook on26 Long-term Chartbook on Trends Long-term oninLong-term Health Trends inTrends Healthin Health
Health, United States, 2016
Health, United Health, States, United Health, 2016States, United 2016 States, 2016
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Industry news Abbott closes acquisition of Alere Inc Abbott (Abbott Park, IL) announced it completed the acquisition of Alere Inc (Waltham, MA) on October 3. Terms of the acquisition were not disclosed, but previous estimated valued the transaction at approximately $5.3 billion. Abbott also completed its previously announced tender offer to purchase for cash all outstanding shares of Series B Convertible Perpetual Preferred Stock of Alere at a price of $402.00 per share of Preferred Stock.
PWH announces HIDA SHC scholarship recipient Professional Women in Healthcare (PWH) (Alexandria, VA) announced Nikki Moore is the recipient of the HIDA Streamlining Healthcare Conference Scholarship. Moore is director, core accounting for McKesson. She has been in the healthcare industry for three years and is passionate about leadership and development. She was recently accepted into her company’s Women in Leadership program and has led various groups in her company through mentorship, development, and innovation. In addition to attendance to the Streamlining Healthcare Conference, she also receives a one year membership with PWH. Congratulations to Nikki Moore, an aspiring leader who is very deserving of the scholarship.
Henry Schein Medical signs exclusive agreement with Terason Henry Schein Medical (Melville, NY) announced that its Emergency Medical Services (EMS) business entered an exclusive agreement with Terason® (Burlington, MA) to distribute uSmart® 3200T NexGen, a portable ultrasound device that enables emergency responders to perform exams in emergency medical transport vehicles and aircrafts. Responders use uSmart 3200T to identify issues at the point-of-care, continue assessment during transport, and alert emergency room staff of relevant vitals. uSmart 3200T NexGen weighs less than five pounds, features proprietary SuperHarmonic™ Imaging capabilities with fast processing speeds, and an intuitive touchscreen design.
Vizient Inc names new president Vizient Inc (Irving, TX) announced that president and CEO Curt Nonomaque plans to retire. He will remain in his current role with the company through March 31, 2018. Byron Jobe, Vizient’s current president, chief administrative and financial officer, has been named president and CEO of the company by the Vizient Board of Directors effective April 1, 2018.
HHS Secretary Tom Price resigns Health and Human Services (HHS) Secretary Tom Price resigned. His resignation came amid multiple investigations into his use of private charter and military jets to travel around the country at taxpayer expense. Price has led HHS since his confirmation in February. President Donald Trump had said multiple times leading up to Price’s resignation that he was “not happy” about the optics of Price’s travel. The White House said that Mr. Trump intends to designate Don Wright as acting secretary. Wright is currently deputy assistant director for health and director of the Office of Disease Prevention and Health Promotion at HHS.
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Wildfires cause hospital closures in Northern California Firefighters are battling more than a dozen wildfires across Northern California that forced more than 20,000 people to evacuate the region. The devastation was severe in Santa Rosa, Calif., where two hospitals were forced to shut down. Sutter Santa Rosa Regional Hospital and Kaiser Permanente Santa Rosa Medical Center were forced to evacuate Monday morning due to the fires. Sutter Santa Rosa transferred 70 patients and 130 patients were moved from Kaiser Permanente Santa Rosa to several other area hospitals.
BETTER CARE
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