What distributors and manufacturers are doing to help safeguard the U.S. healthcare supply chain.
Among most global healthcare stakeholders, tomorrow’s outbreak (or pandemic) isn’t a matter of if – but when, and what. It’s even got an ominous name – Disease X.
According to the Johns Hopkins Bloomberg School of Public Health, Disease X is a placeholder concept that refers to a pandemic pathogen that has not yet been characterized. “Its purpose is to encourage proactive thinking about pathogens that could cause a pandemic,” the school states. “It represents a way to push people’s thinking forward so that they’re not wedded to lists of prior pandemic pathogens, like influenza.”
U.S. healthcare providers, and the distributors and manufacturers who supply them, aren’t taking the threat lightly. In the following two-part series, Repertoire Magazines highlights how the med/surg community is working with customers on their plans, inventory, and contingencies in the event of another outbreak or pandemic.
Henry Schein: Investing in Public-Private Partnerships
There are several ways in which Henry Schein serves customers through the organization’s approach to supply chain resilience and pandemic preparedness, said Allison Neale, vice president of Public Policy at Henry Schein.
First, Henry Schein co-founded the Pandemic Supply Chain Network (PSCN) in 2015. PSCN is a public-private partnership aimed at saving lives by strengthening the resilience of the global health supply chain in response to pandemics. “As the private sector lead of the PSCN, we have worked closely with partners including the World Health Organization (WHO), World Economic Forum, and other key stakeholders to foster coordination and enhance the resilience of the worldwide health care supply chain,” said Neale. “We also collaborate with the Health Industry Distributors Association (HIDA) and the U.S. Strategic National Stockpile (SNS) on this issue. Additionally, we serve as an active member of the U.S. Department of Health and Human Services’ Supply Chain Resilience Working Group.” Through these public-private partnerships, Henry Schein continues to hone preparedness systems to help ensure early warning of future supply chain challenges and sustain the robust pathways of collaboration needed to respond quickly to COVID-19, and future pandemics or emergencies.
Henry Schein also leverages its global scale and supply chain expertise to collaborate with its global supplier network. “This allows us to source the products most in demand by health care providers and quickly vet alternative products when needed, helping our customers best protect the health of their patients, team, and themselves,” Neale said.
Finally, the organization partners with customers to help ensure that they have the operational and clinical care solutions needed to effectively serve patients during an infectious disease outbreak, while also protecting patients and staff. Henry Schein’s medical and dental teams offer clinicians a host of products and solutions designed to reduce the spread of infection, improve air quality for patients and staff, and decrease waste within facilities. “We offer solutions that help providers stay connected to patients and keep them informed during a pandemic or other public health emergency,” said Neale. “In addition, we assist our customers in delivering the highest quality care to patients during a pandemic through solutions such as telehealth.”
Lastly, Henry Schein is a founding member of the Association for Dental Safety (formerly OSAP). “Through our work with the organization, we have remained committed to helping dental practitioners ensure that appropriate infection control is integrated into all levels of the oral health practice,” Neale said.
What healthcare providers need to know
“As our collective experience with COVID-19 underscored, having a plan in place before emergency strikes is key to enabling providers to maintain their ability to effectively serve patients while reducing risk to patients, staff, and the practice overall,” Neale said.
Influenza preparation checklists, prepared by organizations including the CDC and the American Academy of Family Physicians, provide useful guides in helping providers develop robust pandemic preparedness plans for their practices. At a minimum, this should include designing an office management plan covering patient flow, triage, and treatment; preparing for staff illness and absences; cross-training staff for all essential functions; and establishing proper cleaning routines.
While most health care offices already have infection control policies in place, it is worthwhile for practices to review those strategies and have a broad enough plan that accounts for contingency planning in case of product shortages. This may include determining which members of an office require particular levels of protection and prioritizing in advance based on the function of each individual in the office and proximity to patients, Neale said.
Vision, Values, and Goals of the National Strategy for a Resilient Public Health Supply Chain
Goal 1: Build a diverse, agile public health supply chain and sustain long-term U.S. manufacturing capability for future pandemics.
Goal 2: Transform the U.S. Government’s ability to monitor and manage the public health supply chain through stockpiles, visibility, and engagement.
Goal 3: Establish standards, systems, and governance to manage the supply chain and ensure fair, equitable, and effective allocation of scarce resources.
Source: HHS, Administration for Strategic Preparedness and Response (ASPR)
Sekisui Diagnostics: Pandemic Planning Important to Customer Conversations
Luke Christensen, vice president of Global Sales, SEKISUI Diagnostics said approaching the topic of pandemic preparation with customers doesn’t have to be complicated. Initially, reps can ask customers a pair of simple questions: ‘What are your plans for this respiratory season?’ and ‘Anything from last season, or season’s prior you are looking to change/improve?’ From there, the conversation can evolve toward logistical and strategic considerations.
Some of the discussion will inevitably involve assuaging any long-standing worries they may have from their experiences during the height of the pandemic. Even today, healthcare providers are still worried about inventory and availability of product, said Christensen. They haven’t forgotten some of the difficult experiences of supply chain disruptions during the pandemic. As a result, many providers prefer to have on hand multiple testing options in their labs for the same assay. They are also more open now to have a backup distribution partner and more open to buy direct online, via Amazon and from smaller niche distributors.
Providers need to know of any changes to the landscape from their reps, and as soon as possible. “Often there is an assumption that a provider knows any reimbursement changes, or new entrants to the market that could help improve office efficiencies and increase patient care and access to the right diagnostic test for the right patient,” said Christensen. “The provider depends on distribution and manufacturers for this information and consultation.”
They need to be prepared for supply chain disruptions without overstocking products that could eventually expire, which can be a difficult task. Also, having a secondary distributor on hand and ready for when these issues arise is paramount.
Christensen said providers should be evaluating their DX offerings and ensure their needs or patient’s needs haven’t changed, as well as ensure they have pandemic preparedness plans in place to address their patient needs. The following are preparedness steps Christensen recommends providers take:
- Develop and regularly update a pandemic plan to reflect new information and emerging threats.
- Stockpile essential supplies (PPE, medications, vaccines and other essential medical supplies).
- Provide on-going education for healthcare workers on infection control, use of PPE and updated protocols for pandemic response.
- Implement a system for monitoring and reporting disease outbreaks to ID and respond to pandemics early on.
- Establish a clear communication plan within an organization and with public health to get any new info out quickly and accurately.
- Implement infection control measures, including isolation procedures and sanitation practices to prevent spreading a disease.
- Work closely with local, state and federal health agencies as well as other healthcare providers to coordinate response efforts.
- Engage with the community to provide education and address any concerns.
- Expand telehealth services to reduce in-person visits.
- Provide resources for mental health and well-being of healthcare workers and patients who are affected by a pandemic.
- Regular evaluation of the effectiveness of response efforts and adapt new strategies from the lessons learned during a pandemic.
Regular check-ins
Pandemic preparation “surprisingly” comes up rarely, Christensen said, most likely due to the pandemic coming to a close.” It could also be due to what healthcare workers have endured during the last pandemic, whether it be burn out or knowing people who may have passed away from complications due to COVID.
The topic does come up usually before respiratory season is set to begin; however, there is so much uncertainty on how “big” of a season it will be that it is still difficult for providers to fully prepare in confidence for respiratory season, let alone prepare for a pandemic, Christensen said. “At this point, being several years past the initial pandemic, most are well versed in how to handle the changes that have occurred since then and have plans in place should it happen again.”
For distributor reps, it’s best to make the subject a regular part of conversations with customers, rather than something to avoid. “Generally, [customers] are very pleased to be reminded that this should continue to be part of their yearly planning,” said Christensen.
Expanding professional and home testing capabilities
Earlier this year, SEKISUI Diagnostics received EUA clearance for the OSOM Flu SARS-CoV-2 Combo Test for use in professional and home testing settings. The OSOM Flu SARS-CoV-2 Combo Test is a lateral flow immunochromatographic assay intended for in vitro rapid, simultaneous qualitative detection and differentiation of influenza A and influenza B nucleoprotein antigens and SARS-CoV-2 nucleocapsid antigen. It is the first of its kind for OTC, Christensen said, and U.S. produced – thus reducing the chance for supply chain disruptions.
“Our team is engaging with our distribution partners as well as customers to prepare for the upcoming respiratory season,” said Christensen. “With this product, and our well known OSOM rapid tests and new Metrix molecular platform, we have solutions for all types of respiratory infections, as well as helping update your pandemic preparedness plans.”
Concordance Healthcare Solutions: How to Assess a Customer’s Readiness
Late last year, Tim House, national vice president of Sales, Concordance Healthcare Solutions, paid a visit to El Rio Community Health Center and its director of procurement, Timothy Snowball. They had a very clear topic to discuss – pandemic preparedness. House wanted to emphasize the importance of having an ongoing preparedness plan with the Arizona-based healthcare provider.
The plan was multifaceted. Part of it involved sequestered inventory (inventory that is for one specific customer) that enabled their supply chain to have a continuous and predictable stream of PPE products. So, the provider and supplier discussed, planned and executed a strategy to create unique SKUs that only El Rio Health could purchase.
“With that strategy, we partnered in a very transparent manner where they committed to buying stock so that it did not become obsolete,” said House.
Aside from that planning, relationships still mattered, so Concordance assigned a local market account manager (Chrissy Alexander) to support the needs of El Rio Health and the patients they serve.
“We firmly believe that onsite support, a strategically placed distribution center and a mission to positively impact lives is critical to be prepared for the next pandemic,” said House.
Top of mind
In a post-pandemic market, preparedness needs to be a frequent topic of conversation between providers and suppliers. “Our teams consistently have conversations with our customers on what they can be doing to be prepared for the next pandemic,” said House. “At Concordance, we are trying to be a thought leader when it comes to pandemic preparedness.”
As such, the organization has developed technology (Surgence: wearesurgence.com) that assists providers with information that allows them to make strategic buying decisions, proactive inventory planning, substitution recommendations and much more. “We are uniquely positioned to offer this up given our exclusive relationship with Palantir,” said House. “Additionally, we have very tenured account managers that routinely discuss the best demonstrated practices. Our team members are the trusted advisors to our provider partners, and we always go the extra mile to ensure we positively impact their lives.”
Relative to their overall responses, some providers implement the recommendations Concordance outlines – and some do not. “Unfortunately, as a healthcare community, our memories can be very short and we may forget the challenges we faced during the pandemic,” said House. “As trusted advisors we can only continue to reinforce what the best supply chains in the country do and impress upon those who don’t change that change is needed and it should be acted upon.”
Key practices
There are several important factors that providers need to be aware of, House said. Some of these may be reminders of best demonstrated practices but some may be new to their practices. The following are a few key practices House recommends providers implement to ensure a robust and resilient supply chain.
1. Forward thinking individuals
The business of providing patient care cannot continue to be done the same way as it has been in the past. In today’s healthcare environment the supply chain roles are such a critical function that the level of expertise needed to manage the day-to-day activity is much higher. These roles often require a higher level of education or advanced experience. “With that being said, culture and talent will eat strategy anytime,” House said. “Hire the right individuals and don’t be afraid to think about someone outside of industry.”
2. Diversify suppliers
Relying on a single supplier for critical medical supplies can be risky. Healthcare providers should diversify their supplier base to reduce dependency on any one source. “We have seen multiple customers use the strategy of having a dual prime vendor award to thwart this risk,” said House. This could involve establishing relationships with multiple suppliers, including local and other regional (outside of state) partners.
3. Maintain adequate stock levels
Rather than operating on a just-in-time inventory system, healthcare providers may need to keep higher levels of essential supplies in stock to prepare for emergencies. This includes items such as personal protective equipment (PPE), medications, and medical devices. Part of this strategy played itself out with the work Concordance has done with El Rio Community Health. Adequate stock levels don’t necessarily mean product has to be stocked at the provider’s par location; you can establish creative solutions with flexible partners.
4. Flexible supply chains
Healthcare providers should work with suppliers to develop flexible supply chains that can quickly adapt to fluctuations in demand or disruptions in the distribution network. This might involve establishing backup logistics routes or stockpiling certain supplies in strategic locations. If providers end up stockpiling product on their own, they should assign someone on their team to rotate stock and use up the inventory before it becomes obsolete. Replenishment of that product and a strong relationship with the distributor is key.
5. Leverage technology to help sourcing and clinical teams
House said Concordance’s “Surgence” provides the level of intel needed for providers in their day-to-day activity. It includes cross referencing, contract information, DIOH (days of inventory on hand), proactive inventory reporting and much more. “Technology is our friend and we must leverage it.”
6. Develop a pandemic supply plan that is constantly monitored, turned and avoids obsolescence in inventory
Emergency response plans must be clear and concise. Healthcare facilities need robust emergency response plans that outline procedures for managing supply chain disruptions. This includes protocols for reallocating resources, prioritizing critical patients, and coordinating with other healthcare organizations and government agencies. Providers should post the plan, share it with leadership and make sure their distributor can execute on the plan if needed. Depending on the level of expertise of the supply chain, it also might even be a worthwhile task to conduct pandemic preparedness drills with the team. “As my old coach used to say, ‘Proper preparation prevents poor performance,’” House said.
7. Voice of the employee/provider
Providers need feedback from clinicians and patients about their plan. They should discuss their plan with stakeholders and make everyone aware of the proactive nature of their efforts. Over communicating a plan is key so that nobody is caught off guard, House said. “By implementing these strategies and working closely with your distributor partners, healthcare providers can enhance their resilience and preparedness to handle emergencies while maintaining the quality of care for patients,” he said.
Respiratory season reminders
There is perhaps no more opportune time to discuss pandemic preparedness than when providers are planning for the upcoming respiratory season. House said a traditional respiratory season is one that sees spikes in usage of common respiratory products like Influenza/Covid tests, vaccinations, airway management products, pulse oximeters, isolation gowns, facial masks, exam gloves, alcohol prep pads, needles, syringes, sanitizers, etc.
As such, most distributors plan accordingly for those spikes by buying inventory upfront to help support the increase in demand of providers. These types of respiratory events are more predictable and yet they can still cause supply chain/resiliency issues.
“We often have our account managers discuss the provider’s PAR levels and ask them to increase their DIOH to help support the influx of respiratory illness related patients during the flu season,” he said. “Again, these events can be more predictable around cold/flu season, but measures need to be taken to ensure a healthy and robust pipeline. As I look to the future, providers must be prepared to tackle the challenges of the next pandemic and partner with the right manufacturers and distributors to do so.”
Dukal: Ensuring Proper Care Amid a Pandemic
Surprisingly, the topic of pandemic preparedness does not come up nearly enough in discussions with healthcare providers, said Charles Abbinanti, president of Dukal. Pre-pandemic research by the McKinsey Global Institute found that, on average, companies experience a disruption of one to two months in duration every 3.7 years. When these interruptions occur in our industry, the health of patients, families, and communities is left at risk. “For Dukal, patients and all who serve them are at the heart of what we do, and we recognize the essential role manufacturers play in ensuring proper care,” Abbinanti said.
For decades, Dukal has been a trusted source for medical consumables that represent a significant spend within acute and non-acute medical settings, Abbinanti said. “Today, with advancements in supply chain management, IT, and automation, we can provide industry-leading end-to-end supply chain visibility and transparency, improving real-time accuracy to better manage your inventory, cash, and business.”
Dukal communicates with customers that partnering with the company means not worrying about allocation, as their product is assigned from the start of production to their dock. “We work to exceed customer expectations through collaborative decision-making and inventory planning to ensure you have what you need when you need it.”
Addressing concerns
The failure of the global supply chain in response to the outbreak of COVID-19 caused fundamental concerns about the sustainability of today’s health system, increasing demands for supply chain transparency. According to Gartner, 60% of supply chain leaders say their supply chains have been designed for cost efficiency, not resiliency. Creating visibility barriers as siloed processes disrupt many companies from clearly communicating when an order ships, what was shipped, or if there are changes to an order.
Because the supply chain function oversees most of a health system’s external spend, which accounts for up to 40% of total costs, working with a high-performing supply chain can boost resilience, enhance care, increase satisfaction among physicians and reduce supply spend, placing health systems in a better position to achieve growth goals.
“Delays happen,” Abbinanti said. “[Our] Dukal InSight allows us to know about delays 60 to 90 days in advance, updating the customer with a report showing everything they ordered, the status of the shipment, where the products are located, and the new expected delivery date. This allows us to have a conversation with the customer, figure out how it will impact them, and find the best solution.”
Customers immediately see the value a transparent and pro-active supply chain provides them today, as well as during times of disruption, Abbinanti said. “We’ve also had customers ask for our assistance in building out their own order-tracking tools and resources, after learning about our innovative capabilities.”
The new norm
As the healthcare industry continues to grapple with increasing challenges across the manufacturing and supply chain landscape, port congestion and freight transportation issues have continued to emerge as significant disruptors. The need to adjust supply chains in a matter of hours or days rather than weeks has become the new norm.
Recognizing the need for transformative industry change, Dukal launched a cross-functional effort to achieve combined business, IT, and planning benefits. This effort involved cross-functional and cross-geographical teams focused on agility, customer centricity, data interchanges, speed, and customer satisfaction.
The Dukal team implemented Dukal InSight, built on Microsoft’s Dynamics 365 Business Central and in partnership with Mallory Alexander International Logistics’ order management process, to quickly deploy real-time visibility of customers’ orders from purchase to delivery.
“We also increase resiliency through a global footprint and collaborative safety stock programs and build upon our own disaster recovery plans by creating collaborative forecasts and safety stock programs with our customers,” Abbinanti said. “We are also continuing to expand our global footprint (i.e., sourcing product from multiple countries) and host bi-coastal warehouses to provide customers with recovery options even when faced with significant international disruptions.”
Dukal InSight Capabilities
Worldwide Tracking. Dukal said customers can stay informed on their order progress with world-wide visibility.
Compatible Excel Reporting. Provide clear visualizations and reports of inventory availability to cross-functional teams whether it’s in production or in transit.
Automated Communication. Get up-to-date reporting and respond to market disruptions, mitigate risk, and maintain business continuity with weekly automated emails.
Product Tracking at the Item Level. See item details down to the line item with descriptions, unit of measure, order date, planned shipment date, planned delivery date, and current milestone.
Product Assigned at the Factory Level. “Partnering with us means not worrying about allocation, as your product is assigned from the start of production to your dock,” Dukal said.
Proactive Collaboration. With full visibility and a global team, Dukal said it can act with speed and confidence to make proactive decisions to maximize efficiency and avoid costly delays.