This document summarizes a presentation on supply chain in the healthcare continuum. It discusses how the traditional healthcare model is shifting from acute care-focused to a new transformational model that supports various points of care across settings. This includes how facilities, talent, equipment, materials, revenue management, and information will need to adapt to this new model. It also discusses challenges like properly defining class of trade categories as care delivery moves outside hospitals. The presentation argues the supply chain will need new roles, players, and approaches to support the changing landscape of healthcare.
Free medicines are available through the pharmaceutical companies’ Patient Assistance Programs (PAPs), which may be accessed for individual prescriptions using The Pharmacy Connection (TPC) software or through a bulk replacement / Institutional PAP. Learn about Rx Partnership, Virginia’s innovative bulk replacement program.
Learn the relationship between physician productivity and physician pay to better understand how the healthcare system works. Factors like practice expenses and bonuses are also discussed.
Healthcare Supply Chain Management in the USLevi Shapiro
Healthcare Supply Chain Management in the US, presentation by Robert Burkholder, SVP Supply Chain, Jefferson Health System. Delivered on May 11, 2021 for mHealth Israel. Includes an overview of Jefferson, organization chart for Supply Chain Management department, overview of financing Healthcare in the US, discussion about M&A in the US healthcare providers sector, description of how Payers, Providers and Supliers are chasing scale, Jefferson's merger timeline, approach toward Integrating Legacy Supply Chain Departments, breakdown of the Fragile Global Supply Chain, efforts toward Supply Chain Resiliency, Value analysis in the healthcare supply chain, Enterprise Value Analysis, Strategic Sourcing and Purchasing, strategic sourcing model, Sourcing Prioritization Pipeline, Proposed prioritization map, Sourcing Prioritization Matrix, Advanced Analytics
Understanding Relative Value Units (RVUs) - How Doctors Are Paid TodayManage My Practice
This presentation reviews the evolution of the RBRVS model of weighting each medical service provided by a physician, giving examples of how RVUs determine what physicians are paid today.
Free medicines are available through the pharmaceutical companies’ Patient Assistance Programs (PAPs), which may be accessed for individual prescriptions using The Pharmacy Connection (TPC) software or through a bulk replacement / Institutional PAP. Learn about Rx Partnership, Virginia’s innovative bulk replacement program.
Learn the relationship between physician productivity and physician pay to better understand how the healthcare system works. Factors like practice expenses and bonuses are also discussed.
Healthcare Supply Chain Management in the USLevi Shapiro
Healthcare Supply Chain Management in the US, presentation by Robert Burkholder, SVP Supply Chain, Jefferson Health System. Delivered on May 11, 2021 for mHealth Israel. Includes an overview of Jefferson, organization chart for Supply Chain Management department, overview of financing Healthcare in the US, discussion about M&A in the US healthcare providers sector, description of how Payers, Providers and Supliers are chasing scale, Jefferson's merger timeline, approach toward Integrating Legacy Supply Chain Departments, breakdown of the Fragile Global Supply Chain, efforts toward Supply Chain Resiliency, Value analysis in the healthcare supply chain, Enterprise Value Analysis, Strategic Sourcing and Purchasing, strategic sourcing model, Sourcing Prioritization Pipeline, Proposed prioritization map, Sourcing Prioritization Matrix, Advanced Analytics
Understanding Relative Value Units (RVUs) - How Doctors Are Paid TodayManage My Practice
This presentation reviews the evolution of the RBRVS model of weighting each medical service provided by a physician, giving examples of how RVUs determine what physicians are paid today.
Physician Revenue - Getting paid for the work you doRobert Robinson
Gain an understanding of the basics of how physicians are paid - fee for service, quality bonuses, healthcare insurance, revenue sharing and more are discussed in this presentation.
Identifying & Overcoming Gaps in the Specialty-Pharmacy EcosystemCognizant
Specialty drug expenditures in the U.S. are rising dramatically, compelling manufacturers to accelerate the turnaround time from patient enrollment to drug disbursement. Using data analytics tools, these companies can track patients throughout their treatment and ensure continuous patient therapy.
Comprehensive pharmacy services | Point of caredanielbrain10
Learn about our comprehensive pharmacy solutions at the point of care that allow physicians to improve clinical outcomes and increase patient satisfaction.
Guide to CMS Comprehensive Care for Joint Replacement modelQ-Centrix
On April 1, the CMS Comprehensive Care for Joint Replacement (CCJR) model went into effect for nearly 800 hospitals in 67 markets nationwide. Essentially, CMS converted its voluntary payment model—Bundled Payment for Care Improvement (BPCI)—into a regulatory mandate that will hold hospitals accountable for spending by all healthcare providers for 90 days following the initial episode of care.
Orthopaedic Device Industry Business Models: 2020 and BeyondApril Bright
During last year’s closing keynote, Dr. Wael Barsoum underscored the importance of producing transformational, innovative products to stay competitive and maintain a strong company and a healthy supply chain. This year, Dr. Bill Tribe will shine the “innovation lens” on the value of transforming your business.
Dr. Tribe co-authored the often-cited “Medical Devices: Equipped for the Future?” study in which the orthopaedics sector is called out specifically as facing an extreme combination of forces — none of which come as a surprise or are new, but when viewed holistically (as in the image below), paint a rather obvious picture of the need for companies to respond. As you can see, orthopaedics is the only sector with 4 of 5 “hot” areas…and in this case, the odd one out (regulatory scrutiny) is still marked “critical.”
From a top-down view, the five “disruptors” listed above are acute (power shift to payors, regulatory scrutiny, unclear sources of innovation, new healthcare delivery models, need to serve lower socio-economic classes). They impact the overall orthopaedic industry intensely – but how are they impacting you? Dr. Tribe’s Keynote Address will take into account the uniqueness of the OMTEC audience: large and small OEMs, Suppliers and Service Providers.
As stated in the A.T. Kearney study, “Each company faces a different set of headwinds…while the macro-factors held true, individual experiences and prioritization depended on factors such as market geography, product life cycles and go-to-market strategies. The most effective strategies are therefore likely to be company specific.”
What will be your business model in 2020? 2025?
Will you be considering cost-structure, deployment of inventory, commercial logistics, quality and regulatory frameworks, R&D, innovation and data collection?
Dr. Tribe will break down the issues and share potential approaches to help you navigate toward a more relevant and lucrative business model – regardless of where you are in the process.
The State of Consumer Healthcare: A Study of Patient ExperienceProphet
There is a vital change happening in healthcare: People are demanding to be treated as savvy consumers, who deserve choices, convenience and fair prices. The same revolution of consumerism that’s shaking up the way the world buys financial services, airline tickets and groceries is finally underway in healthcare. And as healthcare options multiply, this trend will only accelerate. Providers who are ready to respond by creating a strong patient experience are going to win, and those who aren’t will be left behind.
This presentation explains findings from the patient experience study which was conducted to understand the consumer healthcare experience by assessing the gap between patient and providers’ expectations and perceptions, and arm institutions with the ability to assess their own organization, define a successful strategy, and deliver on it.
View the webinar here: http://bit.ly/1RLgTFX
White Paper - Infection Preventionists: Healthcare’s Guardians at the Gate Ne...Q-Centrix
This white paper examines a key player at the front lines of hospitals’ never-ending battles against HAIs –Infection Preventionists (IPs). It briefly explains their varied roles, responsibilities and new challenges, the difficulty in recruiting these highly sought-after experts, and why and how hospitals should be doing more to help overworked and understaffed IPs be successful. Lastly, it covers new technologies and IP support services that can be integrated into hospitals’ infection control practices.
Demo from the Health Hackathon 2015 at Cornell Tech April 10-12. http://healthhackathon2015.splashthat.com/
Solves the unmet needs of real-time reservations and complete coordination of patient referrals to nursing homes. HandOff is the first and only platform to address nursing home bed availability and overbooking, optinizes patient flow & care, reduces administrative time, and increases patient throughput at the hospital,
Team Members
Allen Wang, MIT MD, MPH '15
Tiffany Lee, Cornell MEng CS '15
Dhruva Chandramahan, Weill Cornell PhD Math '16
Avinash Murugan, Cornell BS Biology '16
Nichita Kulkarni, Cornell BA Biology '16
Will Feng, Cornell BS CS '15
Helena Wang, Cornell BA CS '15
As part of 'Are you seeing 2020', the event held by SFSP-York and the ISA to showcase the IBM Skills truck stopping at York University, Angus Campbell will show us how healthcare is going to change in the next ten years.
How To Boost Hospital Performance By Optimizing Your PharmacyCompleteRx
Assessing and managing productivity is a complex process that takes the rights tools and people. While pharmacy may seem to be a small part of an overall organization, it is actually one of the largest cost centers of a hospital, making it one of the most important departments to optimize and streamline. Learn how your pharmacy’s productivity can impact your hospital’s overall costs, quality, safety and patient satisfaction.
Key Points:
- Analyzing productivity
- Pros and cons of pharmacy productivity management tools
- Use of volume indicators
- Workflows to improve productivity and communication with nursing and hospital staff
As a new generation of local technology companies approach the public markets, it’s critical for us to agree on what “local” actually means today — and how that differs from the its definition a decade ago. New technologies and the intelligence of the Web are coming together to radically reshape local commerce — we’re witnessing the rise of a new connected local economy.
Physician Revenue - Getting paid for the work you doRobert Robinson
Gain an understanding of the basics of how physicians are paid - fee for service, quality bonuses, healthcare insurance, revenue sharing and more are discussed in this presentation.
Identifying & Overcoming Gaps in the Specialty-Pharmacy EcosystemCognizant
Specialty drug expenditures in the U.S. are rising dramatically, compelling manufacturers to accelerate the turnaround time from patient enrollment to drug disbursement. Using data analytics tools, these companies can track patients throughout their treatment and ensure continuous patient therapy.
Comprehensive pharmacy services | Point of caredanielbrain10
Learn about our comprehensive pharmacy solutions at the point of care that allow physicians to improve clinical outcomes and increase patient satisfaction.
Guide to CMS Comprehensive Care for Joint Replacement modelQ-Centrix
On April 1, the CMS Comprehensive Care for Joint Replacement (CCJR) model went into effect for nearly 800 hospitals in 67 markets nationwide. Essentially, CMS converted its voluntary payment model—Bundled Payment for Care Improvement (BPCI)—into a regulatory mandate that will hold hospitals accountable for spending by all healthcare providers for 90 days following the initial episode of care.
Orthopaedic Device Industry Business Models: 2020 and BeyondApril Bright
During last year’s closing keynote, Dr. Wael Barsoum underscored the importance of producing transformational, innovative products to stay competitive and maintain a strong company and a healthy supply chain. This year, Dr. Bill Tribe will shine the “innovation lens” on the value of transforming your business.
Dr. Tribe co-authored the often-cited “Medical Devices: Equipped for the Future?” study in which the orthopaedics sector is called out specifically as facing an extreme combination of forces — none of which come as a surprise or are new, but when viewed holistically (as in the image below), paint a rather obvious picture of the need for companies to respond. As you can see, orthopaedics is the only sector with 4 of 5 “hot” areas…and in this case, the odd one out (regulatory scrutiny) is still marked “critical.”
From a top-down view, the five “disruptors” listed above are acute (power shift to payors, regulatory scrutiny, unclear sources of innovation, new healthcare delivery models, need to serve lower socio-economic classes). They impact the overall orthopaedic industry intensely – but how are they impacting you? Dr. Tribe’s Keynote Address will take into account the uniqueness of the OMTEC audience: large and small OEMs, Suppliers and Service Providers.
As stated in the A.T. Kearney study, “Each company faces a different set of headwinds…while the macro-factors held true, individual experiences and prioritization depended on factors such as market geography, product life cycles and go-to-market strategies. The most effective strategies are therefore likely to be company specific.”
What will be your business model in 2020? 2025?
Will you be considering cost-structure, deployment of inventory, commercial logistics, quality and regulatory frameworks, R&D, innovation and data collection?
Dr. Tribe will break down the issues and share potential approaches to help you navigate toward a more relevant and lucrative business model – regardless of where you are in the process.
The State of Consumer Healthcare: A Study of Patient ExperienceProphet
There is a vital change happening in healthcare: People are demanding to be treated as savvy consumers, who deserve choices, convenience and fair prices. The same revolution of consumerism that’s shaking up the way the world buys financial services, airline tickets and groceries is finally underway in healthcare. And as healthcare options multiply, this trend will only accelerate. Providers who are ready to respond by creating a strong patient experience are going to win, and those who aren’t will be left behind.
This presentation explains findings from the patient experience study which was conducted to understand the consumer healthcare experience by assessing the gap between patient and providers’ expectations and perceptions, and arm institutions with the ability to assess their own organization, define a successful strategy, and deliver on it.
View the webinar here: http://bit.ly/1RLgTFX
White Paper - Infection Preventionists: Healthcare’s Guardians at the Gate Ne...Q-Centrix
This white paper examines a key player at the front lines of hospitals’ never-ending battles against HAIs –Infection Preventionists (IPs). It briefly explains their varied roles, responsibilities and new challenges, the difficulty in recruiting these highly sought-after experts, and why and how hospitals should be doing more to help overworked and understaffed IPs be successful. Lastly, it covers new technologies and IP support services that can be integrated into hospitals’ infection control practices.
Demo from the Health Hackathon 2015 at Cornell Tech April 10-12. http://healthhackathon2015.splashthat.com/
Solves the unmet needs of real-time reservations and complete coordination of patient referrals to nursing homes. HandOff is the first and only platform to address nursing home bed availability and overbooking, optinizes patient flow & care, reduces administrative time, and increases patient throughput at the hospital,
Team Members
Allen Wang, MIT MD, MPH '15
Tiffany Lee, Cornell MEng CS '15
Dhruva Chandramahan, Weill Cornell PhD Math '16
Avinash Murugan, Cornell BS Biology '16
Nichita Kulkarni, Cornell BA Biology '16
Will Feng, Cornell BS CS '15
Helena Wang, Cornell BA CS '15
As part of 'Are you seeing 2020', the event held by SFSP-York and the ISA to showcase the IBM Skills truck stopping at York University, Angus Campbell will show us how healthcare is going to change in the next ten years.
How To Boost Hospital Performance By Optimizing Your PharmacyCompleteRx
Assessing and managing productivity is a complex process that takes the rights tools and people. While pharmacy may seem to be a small part of an overall organization, it is actually one of the largest cost centers of a hospital, making it one of the most important departments to optimize and streamline. Learn how your pharmacy’s productivity can impact your hospital’s overall costs, quality, safety and patient satisfaction.
Key Points:
- Analyzing productivity
- Pros and cons of pharmacy productivity management tools
- Use of volume indicators
- Workflows to improve productivity and communication with nursing and hospital staff
As a new generation of local technology companies approach the public markets, it’s critical for us to agree on what “local” actually means today — and how that differs from the its definition a decade ago. New technologies and the intelligence of the Web are coming together to radically reshape local commerce — we’re witnessing the rise of a new connected local economy.
I'm giving a presentation on 9/19/13 to 3 CBI conferences - Point of Care Summit, Retail Strategy Summit, and Strategic Distribution Planning for Specialty. The topic is how retail pharmacy can serve as the Digital Patient Home in the future. This highlights the emerging opportunity, what some companies are doing, and some of the emerging technology and trends.
Welcome to the Chronic Care Management community. This platform will give you background on payable CCM service codes, identifies eligible practitioners and patients, and details the Medicare PFS billing requirements.
What the Shift to Value Means for PharmaceuticalsMedullan
With the transition to value, payers are insisting that pharmaceutical manufacturers deliver real world evidence of their drug’s efficacy before being allowed on formulary. The cost of new specialty treatments has forced companies to bolster and go beyond clinical trial, proving that their drugs improve health outcomes and reduce the cost of care in actual use. Gathering and compiling the myriad of needed data points requires a digital strategy that connects patients, providers, and payers. These comprehensive digital technology platforms are also effective tools for delivering competitive differentiation, better speed to market, and a source for new and expanded revenues.
Harness Your Clinical and Financial Data with an Enterprise Health Informat...Perficient, Inc.
The importance of Enterprise Health Information Exchange (EHIE) as a key way to empower your physicians and patients and demonstrate meaningful use of electronic health records:
- Present the business case for EHIE as an important architecture that matters to progressive health systems
- Take a look at some of the market-leading EHIE architectures and products
- Provide real exam...ples of organizations that are using EHIE to improve their operations
Unlocking Technology Opportunities in Value-Based Healthcare | Parimal Shah |...UCICove
About UCI Applied Innovation:
UCI Applied Innovation is a dynamic, innovative central platform for the UCI campus, entrepreneurs, inventors, the business community and investors to collaborate and move UCI research from lab to market.
About the Cove @ UCI:
To accelerate collaboration by better connecting innovation partners in Orange County, UCI Applied Innovation created the Cove, a physical, state-of-the-art hub for entrepreneurs to gather and navigate the resources available both on and off campus. The Cove is headquarters for UCI Applied Innovation, as well as houses several ecosystem partners including incubators, accelerators, angel investors, venture capitalists, mentors and legal experts.
Follow us on social media:
Facebook: @UCICove
Twitter: @UCICove
Instagram: @UCICove
LinkedIn: @UCIAppliedInnovation
For more information:
cove@uci.edu
http://innovation.uci.edu/
2016 IBM Interconnect - medical devices transformationElizabeth Koumpan
Emerging technologies such as Internet of Things, 3D Printing are driving the creation of new business models and forcing the Industry for transformation. The product centric model where the Industry main objective was to develop the device, is moving to software and services model, with the focus on Big Data & Analytics, Integration and Cloud.
The maturation of technologies such as social, mobile, analytics, cloud, 3D printing, bio- and nanotechnology are rapidly shifting the competitive landscape. These emerging technologies create an environment that is connected and open, simple and intelligent, fast and scalable. Organizations must embrace disruptive technologies to drive innovation
Industry Perspectives and Future Trends in Population HealthRohan DSouza
Presentation on industry perspectives on the future of population health management. This is a talk I gave at the eClinicalWorks National Users Conference in Nashville, TN (2015). With a lot of buzz surrounding pop health programs, I wanted to provide a roadmap on making the switch and succeeding.
In October 2014, INTEGRATED's Bill Jessee presented "Where Is Healthcare Going? And How Will We Get There?" at Iowa Hospital Association's annual meeting. The presentation focuses on the forces shaping healthcare today, the delivery system changing in response to the environment, and what this all means for hospitals and physicians.
Telehealth Failures & Secrets to Success Conference 2017 by VSee Speaker Series
Karyn DiGiorgio (University of California)
More info at: vsee.com/conference
Similar to SMI - Mike Wentling - Revised - Nov 2013 (20)
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?