If one word could be used to describe the supply chain response to the pandemic, particularly entering into Year 2, it just might be “access.”
During the first year, supply chain professionals and consumers alike struggled to gain access to a cache of products, including disinfectant wipes, hand sanitizer, personal protective equipment (PPE) and toilet paper.
Now in a bit of an overlap, the second year adds the different COVID-19 vaccines into the mix.
A variety of non-acute care facilities continue to struggle for adequate supply, ranging from physician offices to retail pharmacies, urgent care centers, long-term care facilities, supermarkets and “mass vaccination centers” (MVCs), the latter of which sprout to accommodate demand surges and direct compliance in selected demographic areas.
Many of these non-acute facilities may not harbor the logistics expertise of their acute-care hospital compatriots. But they need it and have to obtain it somehow.
Healthcare Purchasing News reached out to a number of supply chain executives with non-acute logistics expertise to share management and performance improvement recommendations and tips.
First up, establish partnerships.
“We have entered into a period where partnerships will become a cornerstone to success; that partnership may be an integrated delivery network (IDN), a distributor, a supply chain technology provider or some combination of these,” Turner indicated. “The key is to perform an honest gap analysis, then understand the value that each one brings via solution or resource. Your future state needs to account for tight and system-driven internal processes, robust documentation in adherence to CDC guidelines, and scalable transportation, storage and admission processes. We have worked with health systems to stand up emergency warehouses, review internal disaster readiness protocols, and modify existing processes to account for the volatile surge around the corner. With every project we encourage proven and established methods, and to lean on your partners when expertise is lacking internally.”
“The best advice is to work with the CDC, state Departments of Health, and the existing pharmaceutical distributors to express concerns in the process and supply or demand needs. The feedback to these parties could be for additional staffing or more product,” he noted.
“The CDC and state Departments of Health websites have the most up-to-date information and distribution procedures available,” Marani continued. “Distributors then have access to wait lists for products. For example, the CDC and State Department of Health may enforce that vaccines are distributed only to retail pharmacies for the time being. Typically, facilities must have an agreement with the CDC to administer vaccines. When they have the agreement with the CDC, non-acute facilities and retail pharmacies can then partner with their distributor to be put on lists for vaccine distribution. The three pieces work together to get the location of the vaccine, but if a non-acute facility is unaware of the process, there is a break in distribution and lack of supply.”
Non-acute facilities that may not have access to product should work as an advocate for patients by helping them with scheduling needs and education, according to Marani.
“Most physician offices do not have access to vaccines right now, but they can still help patients through education about vaccination options and support with scheduling,” he said. “Physician offices could supply patients with scheduling portals for retail pharmacies or assist patients with how to schedule appointments online. Patient care may not mean administering the vaccine in the office but enabling the patient to get access to the vaccination.”
Marani further advises communicating with distributors to identify and plan for products related to vaccine administration, such as gloves and sharps.
“The most important aspect for facilities is constant communication,” Fleming insisted. “If they’re encountering issues, not receiving expected shipments on time or in the expected condition, it’s critical to communicate that to everyone up the chain, including state agencies overseeing vaccination programs, carriers and manufacturers to ensure those issues are being addressed and addressed quickly.”
“These providers should appoint someone in their organization to review program requirements and establish the necessary policies and procedures for vaccine storage, handling, administration and reporting,” Garza noted. “Community pharmacies may also consider joining the Federal Retail Pharmacy Program, designed to improve access to vaccine doses in communities and increase the speed of vaccinations for eligible populations.”
Reach out for national direction, according to Jamie Chasteen, Director of Corporate Development, Cold Chain Technologies.
“Specific guidance from the national regulatory organizations [will] provide not only best practice guidelines but also a detailed, vetted list of approved vendors and approved products to be used,” Chasteen said. “Organizations that have the necessary expertise could still run programs with the resources of their choosing, but others could simply run their programs based on federal guidance.”
Chasteen also urges non-acute care facilities to think bigger and farther out.
“Beyond the current pandemic, we might continue to see non-acute facilities play an important role in the distribution of therapies and vaccines as we have learned the importance of community-level care,” he said. “Over the long run, it’s in everyone’s interest that our non-acute facilities have experience with cold-chain storage practices and access to the proper temperature assurance solutions.”
Azra Behlim, Senior Director, Contract Services, Pharmacy, Vizient Inc., recognizes that the federal government allocates vaccines to state governments.
“Current quantity restrictions vary by geographic areas based on complete allocation control residing with state health departments,” she said. “This authority was granted by the federal government, which purchased those doses and owns the doses. In the future, when manufacturers are able to directly sell the vaccine in the market, this challenge will no longer be present.”
Still, Behlim offers four primary tips for non-acute supply logistics to navigate this and future crises.
1. Engage in more accurate methods for prospective demand planning considering variables such as population demographics in the areas they serve and other providers of the vaccine within a 15-mile radius.
2. Spend time looking at the supply chain management of ancillary supplies (e.g., syringes, swabs, bandages, etc.), calculate an accurate run-rate/burn-rate and define your parameters for safety stock.
3. Set up secondary suppliers for additional growth.
4. Review your current labor management structure and see what flexibility your current structure has for vaccine administration.
“In order for non-acute facilities to effectively distribute the vaccine in appropriate quantities to their patients, they need to understand the anticipated allocation and how much demand exists amongst their patients,” Crampton said.
“While the allocations and timeline will be difficult to obtain from state and federal programs, understanding current demand is possible,” he continued. “Some of MedSpeed’s customers have initiated proactive efforts to pre-register individuals to receive the vaccine through online tools, community outreach efforts and even outreach from primary care clinicians. This allows them to have a greater understanding of the individuals in the community who need the vaccine and what phase each person will fall into based on the state criteria for prioritization. Having this data in hand, makes planning faster once vaccine allocation quantities are available.
“For non-acute facilities that are not affiliated with a health system, we would advise them to work with their state to solicit health system support for the storage and redistribution of vaccines,” Crampton added. “Health systems have the experience, capacity and better access to the tools required for efficient and organized planning and distribution. Often, health systems also have the logistics infrastructure to support these efforts, as they have complex supply chain systems which are built to manage product availability through constantly changing supply and demand levels.”
