1. SMI2U Breakout Session
Supply Chain in the Care Continuum
November 7, 2013
Michael Wentling
Chief Solutions Officer, ROi LLC
2. Agenda
Today vs. Tomorrow
Moving from Traditional to Transformational
– Where are we heading?
– What should we be doing to prepare?
Changing World - Players and Places, Disruptive Forces
Supporting a New Model of Care
Class of Trade Impact?
3. Facilities Talent
Equipment
▶How many
▶Specialized
▶Capability
▶What
▶Where
▶How Much
▶Compatibility
▶Hospital
▶Some Clinic?
▶Where
▶What
▶How much
▶Compatibility
Material
RevenueMgmt
▶How much
▶How to pay
▶Ability to pay
TRADITIONAL:
Manages the Patient through the Acute Care Setting
Diagnostic Procedure Recovery Discharge
Information
▶Who
▶Condition
▶History
EVENTS
4. MEDICARE: Concentrated Costs
Among fee-for-service Medicare recipients,
1 percent account for 14 percent of spending
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of Beneficiaries Percentage of Beneficiaries
Source: HHN Magazine, November 2012.
14%
24%
17%
26%
14%
5%
Next 5%
Next
15%
Second
Quartile
(25%)
Least
costliest
half
(50%)
Most costly 1%
Next 4%
% of Spending % of Beneficiaries
7. A LARGE SOURCE OF REVENUE
Nearly 70% of healthcare execs and other staffers surveyed
expected outpatient care to account for more than 40% of
their hospital / health system’s revenue in five years.
3% 14% 9% 16% 53%5%
% of
annual
revenue Less than
10%
10 – 20% 21 – 30% 31 – 40% 41 – 50% More than
50%
Source: Modern Healthcare, April 2012.
Revenue
14. Where do you think the
Healthcare “puck” is
going to be in the future?
What should we be
doing to prepare for it?
Supporting a New Model of Care
15. Mercy will be a system of care, not
just a collection of destinations.
Home
monitoring
Disease
management
Medical Home Convenient or
retail care
Day surgery
Endoscopy and
outpatient
procedures
Inpatient
care
Chronic
Disease
management
Home care
Traveling nurse
or care coordination
Mobile/
Electronic
access
Imaging and
other tests
in many of
the care venues
Access to multiple
touchpoints of care
Self-directed health
management will be
supported by the care
model.
Supporting a New Model of Care
16. Facilities Talent
Equipment
▶How many
▶Specialized
▶Capability
▶What
▶Where
▶How Much
▶Compatibility
▶Home
▶Urgent
▶Hospital
▶Clinic
▶Where
▶What
▶How much
▶Compatibility
Material
RevenueMgmt
▶How much
▶How to pay
▶Ability to pay
Pre-
Admission Admission Diagnostic Procedure Recovery Discharge
Post-
discharge
Home
Information
▶Who
▶Condition
▶History
PATIENT
TRANSFORMATION: Considers the Key Performance Variables…
…of the Entire Patient Experience
17. The Importance of the Supply Chain
The future will require leadership
Physician Office Supply Chain Service Center Patient Home
STEP 2;
Physician
dispenses 1st
dose of
pharmaceutical
and
electronically
scrips the
pharam and
walker.
STEP 4:
Courier is
automatically
dispatched to
the
appropriate
filling center
for pick up
and delivery.
Routine Physician Office Visit – closed loop supply chain
STEP 1:
Physician sees
patient and
determines that
the patients
needs a heart
monitor and
pharmaceutical
s but also
prescribes a
walking assist
device for the
patient.
STEP 3:
Request is
captured at
supply chain
service center.
Fills script for
med, monitor,
and DME and
stages for
transport.
STEP 8:
Courier offers
additional
common need
supplies
which are
stored
onboard.
(Convenience
sales &
support)
STEP 6:
Courier /
technician
delivers
supplies and
assist with
monitor and
walker set-up
and
operations.
Provides
video tapes or
website
guidance for
patient and
family.
Hospital
STEP 9;
Courier Picks up
monitor, bags
and transports to
hospital
STEP 10:
Hospital
decontaminates
device and stages
for return
STEP 11:
Courier picks up clean
monitor, and transports
to central capital depot in
service center
STEP 5:
Courier has
additional
common need
supplies
onboard to
support needs
not identified
in physician
office.
(Convenience
support)
STEP 7:
Courier
instructs
patient on
automatic
refill process
and concierge
service for
refills.
STEP 7a:
Computer
tracks
expected
pharma
usage and
notifies
customer
service of
follow-up call.
STEP 12:
Central service center refills
physician office pharma
dispenser and any other
supplies needed based on
electronic record of need.
19. Source: Lagano, Stephen. “Understanding Class of Trade Concepts.”
PharmaceuticalCommerce.com January 8, 2012.
Class of Trade Terms
20. Source: Lagano, Stephen. “Understanding Class of Trade Concepts.”
PharmaceuticalCommerce.com January 8, 2012.
Approaches to COT Definition
It is not always
clear how to
address the
application of
COT rules across
actors in the
Supply Chain or
within the same
type of actors.
21. Issues with Identifying Standard COT Across
Different Stakeholders
Retail & Specialty Pharmacies Stakeholder Perspective Hospital & Clinic Pharmacies
Retail and Specialty Pharmacies are both
categorized with a BAC Code "A" and a
BASC Code "0".
DEA
Hospital and Clinic Pharmacies are both
categorized with a BAC Code "B" and a
BASC Code "0".
Consider Retail and Specialty Pharmacies
separate COT based on setting, services
and channel.
GPO
Consider Hospitals and Clinic Pharmacies
separate COT based on product
administration, utilization settings and
manufacturer's product strategy.
Depends on the Manufacturer's familiarity
with the pharmacy and the setting,
services, channel.
Manufacturer
Function of the product administration,
utilization settings and manufacturer's
product strategy.
Some vendors have created a Specialty
Pharmacy COT in response to emerging needs.
Data Vendor
Generally considered Hospital and Clinic
Pharmacies as separate COTs to support the
manufacturer's reporting requirements.
COT terms, applied from different interest angles, lead to different stakeholder approaches
22. QUESTIONS TO PONDER
What ways are you addressing the alternative points of care?
How do we best manage products delivered to alternative
points of care at different acquisition costs?
What can be done to balance proper COT steps with reality of
shifting care outside the acute setting?
Impact of Class of Trade on Product
in the Supply Chain Continuum?
