Manager ambulatory supply chain & pharmacy operations, Centura Health, Centennial, Colorado
The Journal of Healthcare Contracting: Why do you believe non-acute, alternate site locations are vital to not only a health system or IDN, but U.S. health care in general?
Ruvini DeFonseka Schultz: According to the American Hospital Association’s 2019 Annual Survey published in 2021, there are on average 2.4 hospital beds in the U.S. healthcare system per 1,000 people, showing that the acute side is not meant to handle the day-to-day care needs for the U.S. population. Though healthcare system resources are often focused on the acute space where revenue from surgeries and other procedures are generated, for U.S. healthcare to improve long-term health outcomes and promote ongoing patient-centered care, there needs to be more of an investment in supporting non-acute clinicians and departments.
Preventive care management through primary care offices, specialist visits, and long-term care facilities is critical in lowering the cost of healthcare for patients and improving their daily quality of life. If we have more resources in the non-acute space to see patient’s same day when they call with an issue, to follow up within a few hours about test results, or check in with high-risk patients, we can help avoid hospitalizations and emergency department visits, reducing the overall cost to treat. The plans providers create for their patients in the non-acute space help patients get back to doing what they love to do while managing their situation. As technology and medical knowledge advance, there are more services that can be safely performed in the non-acute space, expanding access for care, reducing costs, and saving patient time.
JHC: What are some keys to success for supply chain teams that may be unique to non-acute?
Schultz: Supply chain teams in the non-acute space are in constant transition: locations move addresses, new specialties are added, and associates turnover. The key to my team’s success is collaboration and process improvement.
My small team supports supply chain operations for 330+ locations spanning Colorado and Kansas. We make sure we are included in meetings with non-acute clinical and operations leadership, patient safety, and acute supply chain so we can smoothly implement projects and brainstorm solutions. Participating in our non-acute daily safety huddle with practice managers, medical assistants, nurses, and physician leaders gives our team space to communicate changes to all sites in real time and hear trending issues we can proactively resolve.
Each month my team evaluates our processes, forms, and standards to determine areas that would benefit from process improvement both within our internal workflows and for our end users. We are currently undergoing testing of a new order form for non-formulary items that speeds up processing for our non-acute buyer and our clinic ordering associates. This form is owned by my team so we can update it as changes are requested. Our team is also creating a centralized website for non-acute supply chain, pharmacy, equipment, lab, and purchased services so that information regularly requested of us and by teams we collaborate with is available to all new and current associates. We are hopeful that access to this information will improve our end user experience and compliance.
As the number of clinics we support increase and services expand, our team continues to collaborate with our non-acute locations and supporting departments to improve operations, understanding of supply chain, and the savings we are able to provide.
JHC: How was your department affected by COVID-19? What type of disruptions did you see? How were you able to navigate?
Schultz: From March 2020 through now, COVID-19 has brought about backorders in manufacturing, materials, and product delivery that our teams have never experienced. In the span of a few days our sites went from hardly any need for masks to an extremely high demand. Because order history is what distributors and manufacturers use to determine monthly allocations for PPE and disinfectants on shortage, this caused major procurement issues for our non-acute team. Even where we had allocation, our suppliers didn’t always have stock available. This forced all associates in supply chain to partner and find alternative sources for PPE supplies. There was a lot of filtering through the many scams or price gauging to find good quality, reasonably priced PPE for our associates.
We moved to heavy conservation of PPE, allotting associates in direct patient care only one procedural mask a day. At one point, our healthcare system started manufacturing isolation gowns at our corporate office using trash bags to keep up with COVID floor and testing site demands. In April 2020, our team was tasked with coming up with processes to order and deliver COVID testing supplies for the system at our ambulatory urgent cares and free-standing emergency departments (FSEDs), and later primary care clinics. Early on during COVID, I was invited to participate in our Non-Acute Incident Command with other clinical and operations leaders for our system. This allowed our supply chain team to be a part of decisions that were being made and voice concerns or ideas so that our associates were protected and our patients could continue receiving care. Since January 2021, my team has been coordinating COVID vaccination supplies and supporting pharmacy sourcing of vaccine coolers, temperature monitors, and needles.
JHC: Has the perception/integration by executive leadership of alternate sites within a health system or IDN changed in the last few years? If so, could you explain?
Schultz: Integration for non-acute sites is more accessible than it was in past years because group purchasing organizations, manufacturers, and distributors are willing to support non-acute integration contracts and strategies. As our supply chain partners support integration, it is easier for executive leadership in our healthcare system to see the benefit of integration for non-acute sites. Non-acute supply chain operations at Centura began less than 8 years ago so we are still automating processes and creating strategies to support integration. Today our non-acute locations are in a place where they know to reach out to our central inbox or phone line when they need support. By creating open access to a non-acute supply chain, we are able integrate our operations across our locations and showcase the value and savings of integration. The movement of suppliers and GPOs supporting integration of non-acute locations is a great step to opening conversations with healthcare leadership around the benefits of a dedicated non-acute supply chain team.
JHC: What project or initiative are you looking forward to implementing now or in the near future?
Schultz: A project we will complete this summer gives our non-acute patients access to purchase healthcare items online direct to their home through our distributor partner. This includes COVID-19 home monitoring items, wheelchairs, and other items providers recommend to support patients. We hope that this will benefit both patients and provider by saving time, providing options, and guaranteeing quality items.
We are starting an initiative with our distributor to highlight women or minority owned vendors on our formulary. We are also looking at opportunities available through our GPO for increased diversity in our vendor partners that recognize the communities that we provide care to.
Looking two years into the future, we are exploring what it would look like to have a dedicated non-acute warehouse space for both supply chain and pharmacy that could support cost savings initiatives and lowest unit of measure for slow moving items. This space would also serve as a central location for our team to stage new clinics. This initiative is exciting as it marks growth and increased strategy for our non-acute teams.