Latest / Taking The Supply Chain Pulse / Care Is Moving And Supply Chain Must Move Too

Transcript

Care Is Moving And Supply Chain Must Move Too · Taking The Supply Chain Pulse

• 0:04
  SPEAKER_01: Hello everyone, and welcome back to another episode of Taking Supply Chain Policy.
• 0:09
  SPEAKER_01: I'm Megan with Seanodge Company, and we're glad you're with us.
• 0:12
  SPEAKER_01: In this episode, Fred sits down with returning guest Karen Conway for a wide-ranging conversation that blends personal updates with a look at the latest trends used in healthcare today.
• 0:23
  SPEAKER_01: Together they explore how changes across the healthcare landscape continue to impact supply chains and discuss what organizations should be watching as they navigate an evolving industry.
• 0:33
  SPEAKER_01: Now here's your host, Fred Franz.
• 0:37
  SPEAKER_03: Today we have a return guest, Karen Conway, and she is going to tell us about what she is doing now and her new adventures in life.
• 0:46
  SPEAKER_03: And we're going to talk about healthcare trends and how they relate to the healthcare supply chain.
• 0:52
  SPEAKER_03: Karen, welcome.
• 0:54
  SPEAKER_03: Thank you so much, Brett.
• 0:55
  SPEAKER_03: It's great to be back.
• 0:56
  SPEAKER_03: Great.
• 0:57
  SPEAKER_03: Well, you know, I've I have had tremendous difficulty in following you, mainly because you're traveling all over the world.
• 1:04
  SPEAKER_03: You can't be caught up with and stuff.
• 1:06
  SPEAKER_03: But could you tell everybody what has happened since the last the last time we talked, you were working with your former company and you now have moved on to different things.
• 1:14
  SPEAKER_03: Could you tell us where you are and what you're doing?
• 1:17
  SPEAKER_00: Well, some that's what my whole family asked me as well.
• 1:21
  SPEAKER_00: So I will tell you, I'm traveling just a little bit less because I have a three-year-old granddaughter now, and she's coming to visit um on Thursday.
• 1:30
  SPEAKER_00: So I'm clearing the deck and we're going to the beach and going to the boat.
• 1:34
  SPEAKER_00: Um, but in the meantime, I'm a little all over the place, but doing some fun things.
• 1:40
  SPEAKER_00: I am once again collaborating with Jean Schneller out of ASU and some other professors there.
• 1:48
  SPEAKER_00: But what's really exciting, we are writing another textbook, this time as part of the Springer supply chain series.
• 1:55
  SPEAKER_00: And we're doing it in conjunction with professors from the University College London.
• 2:02
  SPEAKER_00: So we're gonna really explore, because the fact is the our challenges and our opportunities are really similar.
• 2:10
  SPEAKER_00: But we'll do a little compare and contrast, particularly kind of with public procurement and um and uh public and private procurement.
• 2:19
  SPEAKER_00: Uh I am I'm continuing to do some work with SMI and with ARM.
• 2:25
  SPEAKER_00: Um I've been working, this is kind of fun.
• 2:27
  SPEAKER_00: I've been working with a uh a company that does patient engagement for people with diabetes.
• 2:34
  SPEAKER_00: And they go at risk and they also have their own supply chain.
• 2:39
  SPEAKER_00: So they've really been able to lower the cost and increase the availability, particularly to some very vulnerable populations.
• 2:46
  SPEAKER_00: And then I'm doing this crazy thing with improv.
• 2:50
  SPEAKER_00: I've been studying improv for a couple of years now.
• 2:54
  SPEAKER_00: I'm not very good at it, but what I've learned is the tenets that really help us open up to other ways of thinking, because we certainly need that in healthcare.
• 3:04
  SPEAKER_00: We need to understand the finance, the supply chain, the clinical side, the patient side.
• 3:09
  SPEAKER_00: We need to understand the perspectives across that end-to-end supply chain, helps you get better better listener, helps you be more comfortable with uncertainty, and most importantly, it kind of helps us laugh.
• 3:21
  SPEAKER_00: And I think that's what we all need right now.
• 3:24
  SPEAKER_03: Sure.
• 3:24
  SPEAKER_03: And you get past uh whatever barriers people may have uh constructed uh around themselves.
• 3:31
  SPEAKER_00: You know what I mean?
• 3:32
  SPEAKER_00: Yes.
• 3:32
  SPEAKER_00: I mean, we all have our unconscious bias.
• 3:35
  SPEAKER_00: Sometimes we even have conscious bias, you know, and when we take the time to listen, we start understanding kind of it's all about, I think, coming back to that common purpose.
• 3:46
  SPEAKER_00: Why didn't we all go in into healthcare, whether you're a clinician or a non-clinician?
• 3:51
  SPEAKER_00: I think we wanted to help people.
• 3:54
  SPEAKER_00: And in this time of high burnout, you know, that ability to come back together and let's start with what we um have in common, and then we can build from there and learn from one another.
• 4:06
  SPEAKER_03: Yeah, and what we have in common, what it once we allow ourselves to have our barriers broken down, yes, is our is our humanness.
• 4:15
  SPEAKER_03: And a lot of a lot of people really that's a very difficult thing for them to do is allow themselves to be seen as being human.
• 4:23
  SPEAKER_03: They have to be seen as being in control, being powerful, being whatever.
• 4:27
  SPEAKER_03: But once we get to, once we become human, that's how we can move forward.
• 4:30
  SPEAKER_03: And you've always been excellent at doing that, Karen.
• 4:32
  SPEAKER_00: Well, thank you.
• 4:33
  SPEAKER_00: And you too, Fred.
• 4:34
  SPEAKER_00: I think, you know, and the other thing is it's fascinating what happens in the brain.
• 4:38
  SPEAKER_00: You know, I mean, when we're we have a lot of stress in healthcare, you know, and you think about just even shortages in the supply chain and the amount of time.
• 4:48
  SPEAKER_00: I think Visiant came up with a study recently just for drugs.
• 4:52
  SPEAKER_00: It's like adding 20 million hours per year to the amount of time, you know, that we just have stress because we don't make sure we've got the right products when we need it.
• 5:03
  SPEAKER_00: But, you know, so we get this stress, and when we have stress, we're all operating in that fight or flight part of our brain.
• 5:10
  SPEAKER_00: And when we get curious or when we reach out and offer to help, even if we just ask for help, it shifts where things happen in the brain, and we can be we we can problem solve better and we can be open.
• 5:25
  SPEAKER_00: That human connection is so important.
• 5:27
  SPEAKER_03: It it sure is.
• 5:29
  SPEAKER_03: Um, so let's talk about some of the I'll I'll let you lead the way about what what trends you're you think we should be talking about in healthcare and how those trends relate to supply chain.
• 5:42
  SPEAKER_03: So pick one and start off.
• 5:44
  SPEAKER_03: Sure.
• 5:45
  SPEAKER_00: Uh I think you know, we hear certainly a lot about some of the challenges in terms of um funding.
• 5:53
  SPEAKER_00: You know, we've got the one big beautiful bill, or what I call OB3, um, because it's just easier to say, you know, that's got a lot of upcoming cuts.
• 6:04
  SPEAKER_00: A lot of them, they'll come into phase over time.
• 6:08
  SPEAKER_00: But they, you know, you're gonna particularly it depends on what state you're in as well.
• 6:14
  SPEAKER_00: That's the other thing.
• 6:15
  SPEAKER_00: We look a lot at the federal government, but I think increasingly the federal government is pushing a lot more to the states.
• 6:22
  SPEAKER_00: And so I think healthcare systems will have to look at the various states that are operating in.
• 6:27
  SPEAKER_00: And some of the big systems are obviously operating, I think like Trinity operates in 27 different states.
• 6:33
  SPEAKER_00: So we really need to pay attention to some of the regulations there.
• 6:40
  SPEAKER_00: But I think, you know, and then we have to look at rural health care, and there's some opportunities in rural health care, but I think, you know, so efficiency is critical, always has been, but I think will be increasingly so.
• 6:54
  SPEAKER_00: Probably the biggest trend I see is this continued move to care outside of the walls of the acute care hospital.
• 7:04
  SPEAKER_00: We saw something like 275 different procedures go off of the inpatient-only list just this year.
• 7:14
  SPEAKER_00: The government has, the federal government has stated it wants to move to completely site neutral.
• 7:20
  SPEAKER_00: American Hospital Association has been able to stave off a lot of that, but that's the direction we're going.
• 7:27
  SPEAKER_00: So I think hospitals and healthcare systems really need to understand from a clinical and financial perspective where's the best place to deliver care.
• 7:38
  SPEAKER_00: Because if you move to a hospital outpatient department, it's about, I think, maybe a 25% cut, I think is what it is in terms of your reimbursement.
• 7:51
  SPEAKER_00: You get into an ambulatory surgery center, it could be half.
• 7:55
  SPEAKER_00: And in an ASC, in some cases, the implant isn't even covered.
• 8:01
  SPEAKER_00: So having that efficiency and that data, that granularity of understanding what are we actually using, what is the total cost of care.
• 8:13
  SPEAKER_00: And what's interesting, I'm starting to see value analysis professionals starting to say payer reimbursement.
• 8:20
  SPEAKER_00: You know, they've always cared about cost, certainly about clinical efficacy, but starting to understand where products are used, on which kinds of patients, so that they can start understanding you know, what's the what are the financial implications?
• 8:38
  SPEAKER_00: Because the fact is, we got to keep the doors open.
• 8:41
  SPEAKER_00: You know, we're in the business of caring.
• 8:44
  SPEAKER_00: We have to do both really, really well.
• 8:47
  SPEAKER_03: Yep.
• 8:47
  SPEAKER_03: Well, you know, the you're sort of uh I I know you haven't read it because you're too busy.
• 8:53
  SPEAKER_03: But um a couple weeks ago I wrote an article called The Next Big Thing, and I got into the idea of of uh healthcare moving away from the fixed central point of the acute care hospital uh outward.
• 9:06
  SPEAKER_03: Uh because I live in Northeast, I live in Cleveland, and the Cleveland Clinic alone has a hundred uh different sites around Northeast Ohio.
• 9:15
  SPEAKER_03: And and the next big thing, in my opinion, for supply chain is logistics and transportation.
• 9:23
  SPEAKER_03: Having to service uh well a hundred sites with different needs, different people working there, less oversight of the activity within the supply chain, if you will, uh becomes a daunting challenge that requires a level of knowledge that heretofore we didn't have to know about that.
• 9:42
  SPEAKER_03: When I started out, you just had to know how to back the truck up to the dock, unload it, and push the stuff to where it needed to go.
• 9:48
  SPEAKER_03: And that's way different now.
• 9:49
  SPEAKER_00: Yeah, I mean, the where the stuff needed to go was, you know, maybe to the fifth floor, down this hall, into that storeroom, et cetera.
• 9:57
  SPEAKER_00: When you go, and you mentioned Cleveland Clinic, um, you know, they're also very, very active in Florida.
• 10:03
  SPEAKER_00: Um, and in fact, one of the hospitals that they own in Florida, my father used to be the vice chair, and they have an active hospital at home program there, you know, and you start thinking about what has to be delivered.
• 10:17
  SPEAKER_00: And this is where I think it will have ripple effects upstream, Fred, in terms of we'll start breaking down those silos between the supply chain that operates medical, surgical, and devices and pharma and equipment, and even the personnel.
• 10:36
  SPEAKER_00: Because we've got to deliver all of that.
• 10:39
  SPEAKER_00: Because you might have the infusion pump, but if you don't have the chemotherapy drug, or what if you don't have the licensed practitioner to operate that equipment?
• 10:49
  SPEAKER_00: Um, or what do we have to do to make sure that the homes are conducive to that kind of care?
• 10:55
  SPEAKER_00: And I always remember this story.
• 10:57
  SPEAKER_00: I was working with a cardiologist.
• 10:59
  SPEAKER_00: He used to do population health for Geissinger, and he talked about these nurse practitioners that worked for him, and they loved their jobs and they went and did home visits.
• 11:09
  SPEAKER_00: But they, you know, would say, Doctor, you know, I love my job, but this morning you had me going north, then I went south, then I went north again, then I went east, then I went west.
• 11:20
  SPEAKER_00: And so he and I started talking about supply chain and logistics, and you know, using tools that uh Amazon or a UPS uses to make sure that the routes are planned as efficiently as possible.
• 11:34
  SPEAKER_00: Um, it impacts the personnel as well.
• 11:36
  SPEAKER_03: Yeah, and and the other thing that's always happened is as systems grew, uh the various departments maintained individual responsibility for things.
• 11:46
  SPEAKER_03: So you may have a laboratory driver going one place, passing the pharmacy get driver going the same place, or you know, not even coming close to optimizing uh the way uh things are are uh used in an in an organized fashion.
• 12:00
  SPEAKER_03: So these are these are opportunities I think that once again require expertise that we didn't have, or uh we didn't have to have, and are gonna make a uh a big difference.
• 12:10
  SPEAKER_03: One of the things you talk about is federal government policy proposals.
• 12:15
  SPEAKER_03: And I want to I had um yesterday I was having a conversation with Dr.
• 12:19
  SPEAKER_03: Ruben Pillet from uh University of Alabama, Birmingham, and he talked about the idea of what we during uh COVID, you know, telemedicine became important, and he thinks that he thinks that the ability to utilize push out technology to the home is going to relieve a lot of issues.
• 12:39
  SPEAKER_03: But the immediate thing that has happened in my opinion, I'd like to hear your opinion about this on care and even the supply chain, is that the OB3 bill that you talked about has virtually gutted um access to uh healthcare for many rural areas.
• 12:59
  SPEAKER_03: And and um, you know, how do you think that's gonna be how do you think that's gonna be circumvented or surmounted?
• 13:07
  SPEAKER_03: And what what is what effect is that gonna have on supply chain?
• 13:10
  SPEAKER_00: Yeah, I think the rural is is so absolutely critical.
• 13:14
  SPEAKER_00: I think um I think I read something.
• 13:16
  SPEAKER_00: So, you know, we've got about 140 billion in Medicaid cuts.
• 13:21
  SPEAKER_00: We do have about 50 billion in OB3 for this rural healthcare transformation.
• 13:28
  SPEAKER_00: But, you know, if you think about the rural hospitals and healthcare systems, one of the biggest challenges, I was at an AHA conference on sustainability last year, and they had several leaders.
• 13:39
  SPEAKER_00: Um, you know, they weren't just a supply chain leader, they wear multiple hats in some of these smaller hospitals.
• 13:47
  SPEAKER_00: And they had a number of their of the funding for a number of their infrastructure programs, like oftentimes for alternative energy, cut.
• 13:56
  SPEAKER_00: And, you know, they had already spent money, they'd already broken ground.
• 14:00
  SPEAKER_00: So that was a challenge.
• 14:02
  SPEAKER_00: You know, you've got about, I think it's something like 40% operating at a loss.
• 14:07
  SPEAKER_00: We could lose more than 400 rural hospitals.
• 14:11
  SPEAKER_00: Now they are in the process right now of applying for different kinds of grants.
• 14:16
  SPEAKER_00: And I've looked at a lot of them on our own workforce, some of them are on technology development.
• 14:22
  SPEAKER_00: Telehealth is a huge part of that, you know, and there's so much we could do.
• 14:27
  SPEAKER_00: Not just caring for patients via telehealth, as long as we have the broadband and as long as we have people who have that digital literacy, they're comfortable enough with it.
• 14:37
  SPEAKER_00: We could also do a lot with, you know, clinicians training other clinicians to be able to deliver care.
• 14:45
  SPEAKER_00: But we still need to get the stuff there.
• 14:48
  SPEAKER_00: It's still a logistical challenge.
• 14:51
  SPEAKER_00: And one of the stats I saw, Chartist Group did a great report recently, uh, came out, I think in February on the state of rural health care.
• 15:00
  SPEAKER_00: And what I didn't realize, if you took the budget of and looked at the budget of a rural hospital, they're spending somewhere around 24-25% of their budget just on supplies.
• 15:14
  SPEAKER_00: You know, in an urban hospital, that's more like, or even a suburban hospital, that's more like 12 to 14 percent.
• 15:22
  SPEAKER_00: Right.
• 15:22
  SPEAKER_00: And they've got a lot of older technology, it's a bit of a patchwork, getting that interoperability.
• 15:29
  SPEAKER_00: How do we help them invest?
• 15:32
  SPEAKER_00: A lot of them are affiliated with larger systems that, and they can use they're much more dependent than larger systems on their GPOs.
• 15:41
  SPEAKER_00: So they get some help in negotiating price, but they don't have those tools to be able to really start understanding their cost of care, their margin, um, what they're actually using, how to optimize staff, so much back office investment that I think we could deliver.
• 16:00
  SPEAKER_00: Um, and and you know, how do we, you know, technology companies tend to build to kind of the mid to large size?
• 16:08
  SPEAKER_00: Um, you know, those are the big customers, but how do we start packaging some solutions that work for the smaller players?
• 16:17
  SPEAKER_03: Yeah, that that's a challenge.
• 16:19
  SPEAKER_03: I um the question is how many, how many do you think that we will end up with a hundred super large IDNs and that's it?
• 16:30
  SPEAKER_03: Or do you think that is there any chance of the of the medium-sized uh IDNs and some rare standalone community hospitals uh surviving into the future, or do you think that's going to become a thing of the past?
• 16:45
  SPEAKER_00: You know, I wish I knew.
• 16:47
  SPEAKER_00: Uh, you know, I think we will continue to grow towards more of these larger systems, just because we, you know, the primary reason has been to have more negotiating power with payers, to be honest.
• 16:59
  SPEAKER_00: But I think you start seeing more economies of scale.
• 17:03
  SPEAKER_00: I think if there were ways that we could somehow, and ideally maybe through incentives, to get some of these larger systems to be able to, you still have to have that hands-on care in the community.
• 17:20
  SPEAKER_00: The majority of it, I would believe, is really around chronic disease.
• 17:26
  SPEAKER_00: It's around behavioral health.
• 17:29
  SPEAKER_00: I mean, you need to have like some way to treat, you know, the emergency, you know, the accident that happens and to be able to stabilize, but then figure out how do we get those patients as quickly as possible, you know, into you know, into a bigger center.
• 17:46
  SPEAKER_00: But how do we keep people healthy?
• 17:49
  SPEAKER_00: Because the reality is there's a higher rate of chronic disease, people live with more comorbidity, they die sooner.
• 17:57
  SPEAKER_00: And and there's a lot of stress.
• 18:00
  SPEAKER_00: So, how do we start organizing around that?
• 18:04
  SPEAKER_00: Because there's got to be some place for people to go.
• 18:09
  SPEAKER_02: Before we dive back in, you may be asking yourself, is my supply chain future ready?
• 18:14
  SPEAKER_02: At the C Nodge Company, we don't just optimize logistics, we engineer smarter, leaner, and more resilient systems from end to end, from manufacturing to retail to healthcare.
• 18:24
  SPEAKER_02: Our experts bring decades of experience in cutting edge strategies to transform your operations.
• 18:30
  SPEAKER_02: Visit and discover how we're shaping the future of supply chain one solution at a time.
• 18:36
  SPEAKER_03: Yeah, and uh that was the kind one of the part of that conversation with uh Dr.
• 18:40
  SPEAKER_03: Pillet uh yesterday was the uh the need to focus on uh health care versus sick care.
• 18:48
  SPEAKER_03: We we have we have always had in uh uh a since I've been in this business, which is over 60 years, a sick care system where people present themselves when they're sick and they get treated for being sick.
• 19:01
  SPEAKER_03: And the best way to uh have a great health care system is don't get sick.
• 19:07
  SPEAKER_03: And the best way to do that is to live a healthy life, none of which is promoted in our culture.
• 19:14
  SPEAKER_03: How do you turn a culture around?
• 19:16
  SPEAKER_00: Yeah, well, so some of it is us, you know, we've met the enemy and it's us, you know.
• 19:22
  SPEAKER_00: So it's taking our own personal responsibility because I think the fact is, in some cases, I mean, we we live in a country that has amazing innovation, but I think sometimes people sit back and they just go, Well, I can live like this and medical science will fix me.
• 19:38
  SPEAKER_00: Well, that, you know, there is uh the the economics aren't necessarily there.
• 19:44
  SPEAKER_00: But the problem is our system has been set up to create incentives to do more, not less.
• 19:52
  SPEAKER_00: But we do have, and it's interesting, I you know, I mentioned working in the US and working with UK, even the UK, where you would think you've got one organization that is paying for all of health care.
• 20:05
  SPEAKER_00: It's essentially the taxpayers into the central government.
• 20:08
  SPEAKER_00: You would think that they would be set up far more to be focused on preventative care, address, trying to prevent or at least manage chronic disease.
• 20:18
  SPEAKER_00: They have similar challenges to us.
• 20:20
  SPEAKER_00: Spend about 75% of their budget on that.
• 20:23
  SPEAKER_00: We spend about 90% of our money on chronic disease and behavioral health, but they're working on it.
• 20:31
  SPEAKER_00: And then if you think about the concepts of capitated, global capitated payments, you know, this is the Kaiser model.
• 20:39
  SPEAKER_00: You get paid a certain amount to take care of X number of members of a system.
• 20:46
  SPEAKER_00: And certainly during COVID, when hospitals couldn't make money on elective surgeries, those were the organizations.
• 20:55
  SPEAKER_00: And even in like primary care, when it was more capitated, when more value or risk-based, money was still coming in.
• 21:04
  SPEAKER_00: Quite frankly, it's why the you know the insurance companies were doing so well during that period of time.
• 21:10
  SPEAKER_00: We can structure this so that we can create incentives.
• 21:16
  SPEAKER_00: It's you know, transition is always a bit painful, but I think we can get there.
• 21:21
  SPEAKER_00: And then again, it's kind of understanding.
• 21:23
  SPEAKER_00: It's not either or, it's both and what works best in what kinds of circumstances.
• 21:30
  SPEAKER_03: Well, um, you know, uh in our conversation uh the other day, Dr.
• 21:35
  SPEAKER_03: Pillet was very optimistic because of the younger the youngest generations tend to be tend to be less um capitalistic and uh and more holistic in their view of the world, as well as being far more technologically uh capable than than we ever were.
• 21:56
  SPEAKER_03: So so you put those two things together, he thinks there's a fighting He thinks there's a fighting chance out there.
• 22:02
  SPEAKER_03: Um what what are supply chain's operational challenges going to be through all this from what you've seen?
• 22:08
  SPEAKER_03: I I want to say one thing before you answer I was I was talking to somebody uh at a system in New England.
• 22:16
  SPEAKER_03: This is a this is a these have been around a while.
• 22:19
  SPEAKER_03: They got several hospitals, and for each hospital, they still haven't created a centralized item master.
• 22:26
  SPEAKER_03: Still, this is not new stuff.
• 22:28
  SPEAKER_03: This is, I mean, you the reason I'm asking you is you came from a company that was sort of a a technological innovator that really moved things forward uh and and uh became the biggest uh in that field uh in in the healthcare industry.
• 22:43
  SPEAKER_03: And yet what I'm seeing and hearing is we are still many places in what I would call a third uh level country developmental stage.
• 22:53
  SPEAKER_03: Is that how do we get beyond that?
• 22:55
  SPEAKER_00: You know, it just it's a little bit mind-boggling.
• 22:58
  SPEAKER_00: I mean, data is so foundational.
• 23:01
  SPEAKER_00: And I'm I'm even hearing conversations now where people will say, you know, I've worked a lot on data standards, not because I'm a standards geek, but because I know the value in so many different areas if we have good data that we can be looking at from multiple perspectives.
• 23:20
  SPEAKER_00: You know, I always kind of envision this sandbox where you've got the clinical and the financial and the and the um operational folks sitting around it and they're all looking at the same common set of data, and then adding their perspectives, and together we can come up with a better solution.
• 23:38
  SPEAKER_00: But I'm starting to hear these comments now about oh, well, AI will just fix this.
• 23:43
  SPEAKER_00: Well, the fact is, AI can't fix it if the foundational data isn't good.
• 23:50
  SPEAKER_00: So one of the things, um, just recently CMS came out with a proposed rule that is asking hospitals, they have to attest, yes or no.
• 24:02
  SPEAKER_00: Are you electronically capturing the unique device identifier, you know, that standard identifier, the barcode, if you will, on a product electronically and getting it into the electronic medical record for implants, which is actually something that's required.
• 24:18
  SPEAKER_00: All you have to do is say yes or no.
• 24:20
  SPEAKER_00: If you don't answer the question, you could actually get a ding on your reimbursement.
• 24:26
  SPEAKER_00: And that's what starts to get people beyond just maybe the people responsible for the data in supply chain to start thinking a little bit differently.
• 24:37
  SPEAKER_00: But I think to your point, you know, when I talk to supply chain leaders, you know, they're about yes, we've got to work on resilience.
• 24:47
  SPEAKER_00: How do we manage this?
• 24:49
  SPEAKER_00: You know, we've we try, we have, you know, costs have gone up, energy costs in particular, which impacts so many different things.
• 24:58
  SPEAKER_00: But, you know, so we have to work on cost, but we also need to make sure that we've we've got options, buffer stock, different kinds of contracts, agreements, etc., to make sure that we have the supplies.
• 25:12
  SPEAKER_00: But more and more I think it really is understanding what, you know, what is the total cost to care for a patient?
• 25:24
  SPEAKER_00: And it's requiring, you know, and what is it that contributes to better outcomes?
• 25:29
  SPEAKER_00: So we always focus a lot on things like the implants because they're often the highest price product.
• 25:36
  SPEAKER_00: But we need that granularity and understand that variability in, you know, blood use, in, you know, kind of the instruments we're using, um, the different drugs that we're using.
• 25:49
  SPEAKER_00: I have a great story, a friend of mine, she's an electrophysiologist, and she would talk about the fact that when she was at a heart hospital in Albuquerque, and they were doing a procedure, I can't remember which one it was, but there was one particular electrophysiologist who always had better outcomes, fewer complications, I think related, um can't remember what that is either, but uh fewer complications, and they couldn't figure it out.
• 26:17
  SPEAKER_00: And they were like, you know, are you using a different, you know, this different product, are you doing it differently?
• 26:23
  SPEAKER_00: And there was no difference.
• 26:25
  SPEAKER_00: They finally dug into the data enough and discovered he was giving a prophylactic aspirin before he started procedure.
• 26:34
  SPEAKER_00: That was the only difference.
• 26:35
  SPEAKER_03: A 25 cent addition, huh?
• 26:37
  SPEAKER_00: Yeah.
• 26:38
  SPEAKER_00: But until you get to that granularity of data and understanding the variation, um, you mentioned Cleveland Clinic earlier, you know, they're doing some amazing work, top-down, you know, led by physicians to standardize.
• 26:56
  SPEAKER_00: Um, I think they have standardized the procedure cards, they're not preference cards, for 170 different procedures.
• 27:04
  SPEAKER_00: They're even standardizing the instrument trays.
• 27:07
  SPEAKER_00: And it's the clinicians driving it.
• 27:11
  SPEAKER_00: But now they know hey, if we look out, we look at our scheduling, we know how many lap coalies we're going to do.
• 27:19
  SPEAKER_00: Now we can make sure we are supplied, but we can also feed that data to the suppliers as well.
• 27:25
  SPEAKER_00: I mean, the data is so powerful on so many different levels.
• 27:29
  SPEAKER_03: Yeah, and I'm proud to say that we've been working extensively with uh the with the Cleveland Clinic on uh several of these projects.
• 27:37
  SPEAKER_03: And another thing that Cleveland Clinic is also um a leader in, and I think most organizations uh need to adopt this, is becoming is really um spelling out what collaborative relationships with their suppliers mean and what they expect and what they're willing to do both ways.
• 27:57
  SPEAKER_03: Uh we have always wanted to collaborate as long as I win, you know.
• 28:01
  SPEAKER_03: Uh right.
• 28:04
  SPEAKER_03: And and now I think people are starting to understand the necessity to collaborate so that so that everyone benefits.
• 28:12
  SPEAKER_03: And uh and that may be one of the more uh optimistic things to look forward to as well.
• 28:18
  SPEAKER_00: So absolutely.
• 28:19
  SPEAKER_00: I think you know it's changing the nature of the game.
• 28:21
  SPEAKER_00: Where I, you know, I mentioned being at SMI last week, we've gotten more and more conversations going on between the supply chain leaders at manufacturers and distributors with those in hospitals.
• 28:36
  SPEAKER_00: I mean, the sales, the commercial folks are still involved in that, but that's when we can really start changing um how we do business together.
• 28:46
  SPEAKER_00: And one of the other things that I, you know, came out of the conversation I had with Steve Downey on podcast that I just started was um, you know, we all talk about resilience and how we can work with our trading partners on that.
• 29:00
  SPEAKER_00: They're really digging into what are the risks, you know.
• 29:04
  SPEAKER_00: So, because risk is so related to resilience.
• 29:07
  SPEAKER_00: And, you know, the manufacturer might see risks a little differently, the doctor might see risks a little differently.
• 29:14
  SPEAKER_00: We pull those all together, we flesh them out, we share them, we prioritize them, and then we work together to try to minimize it because it impacts all of us.
• 29:26
  SPEAKER_03: Yeah, absolutely.
• 29:28
  SPEAKER_03: Uh, you know, I think one of the biggest problems with healthcare is that healthcare is a humanistic concept, a humanistic uh organism trapped in a capital-driven culture.
• 29:43
  SPEAKER_03: And uh that's the that's the hard thing is to uh to maintain true to a mission and still uh operate within a system where making profit is a and returning profit to the shareholders is the primary motive, right?
• 29:58
  SPEAKER_03: That's tough.
• 29:59
  SPEAKER_00: And I think we can do both.
• 30:02
  SPEAKER_00: Sometimes we have that bias.
• 30:03
  SPEAKER_00: I remember, you know, decades ago when I started working in supply chain, you know, it was you know, it was that kind of standard, oh, well, I'm a clinician, I care about taking care of patients, and you in the finance office or supply chain, all you care about is the business side.
• 30:19
  SPEAKER_00: And the people, you know, in the business office would say, Well, you surgeons, all you care about is just being able to do whatever you want.
• 30:26
  SPEAKER_00: Well, it's, you know, maybe in some small areas, but it's really not the case.
• 30:32
  SPEAKER_00: You know, we all want to make all of this work together, but we need to have those kinds of conversations, and then we need to figure out what are new business models.
• 30:42
  SPEAKER_00: One of the ones I'm really interested in is um, and I I know about that much, you know, just a little bit, but kind of an idea of servitization.
• 30:51
  SPEAKER_00: So more of instead of I'm just selling you this product, particularly in the capital equipment world, but I'm you know, maybe we co-own the product.
• 31:01
  SPEAKER_00: Maybe there's different ways that we can maximize so that, you know, instead of me as a supplier having to make a product that becomes obsolete, you know, is becomes obsolete, you know, so I can sell you more.
• 31:17
  SPEAKER_00: Maybe there's a way I can make money without us having to continually repurchase things or buy new things, create more landfill, create more problems, etc., and still make money.
• 31:33
  SPEAKER_00: But we can't figure that out, you know, because you know, people need to have jobs and people need to make money.
• 31:40
  SPEAKER_00: And I believe in that, but it doesn't mean we can't do it in a way that supports the mission.
• 31:47
  SPEAKER_00: And that mission, in my opinion, you know, the outcome of this healthcare system should be optimal health for all of us, including our organizations.
• 31:58
  SPEAKER_03: I appreciate that.
• 31:59
  SPEAKER_03: Karen, it's thanks again for being on the uh on the podcast again.
• 32:03
  SPEAKER_03: And I think we have a third time coming up.
• 32:06
  SPEAKER_03: Uh, I don't know if you know, but I've had Mark Van Summer.
• 32:09
  SPEAKER_03: Every time Mark Van Summer writes a book, he wants to be on the podcast so he can market the book.
• 32:14
  SPEAKER_03: Yeah, and uh and and you and uh Gene uh are coming out with I think this will be a uh a great textbook, and I'd love to have you both on the podcast once that uh comes out so we can talk about it.
• 32:27
  SPEAKER_03: Be prepared.
• 32:27
  SPEAKER_03: You will probably get one-fifth of the amount of time to speak as you normally would because you would be there.
• 32:33
  SPEAKER_00: But I'm with Dr.
• 32:34
  SPEAKER_00: Schneller, you know.
• 32:35
  SPEAKER_00: I have learned a lot from him for so many years.
• 32:39
  SPEAKER_03: You have to learn to box out so you can get the rebound and you know, force those elbows in there so you get a chance to talk.
• 32:45
  SPEAKER_03: But I I I I really believe that uh that we are becoming more professional.
• 32:49
  SPEAKER_03: We're requiring more professionalism, and the more people learn about things like uh you're doing, I think is gonna help them personally and help their organizations as well.
• 33:00
  SPEAKER_03: So thanks again for being here, Karen.
• 33:02
  SPEAKER_03: It's always a pleasure to have you uh on the podcast.
• 33:05
  SPEAKER_03: And you um it sounds like things are grow going well.
• 33:08
  SPEAKER_00: So they're busy, and as I said, I think as we all just keep learning, and I think the biggest way is we ask more questions.
• 33:16
  SPEAKER_00: So thank you for all your good questions today.
• 33:19
  SPEAKER_03: Thank you.
• 33:19
  SPEAKER_03: Thank you so much.
• 33:23
  SPEAKER_01: Well, that's all for today.
• 33:24
  SPEAKER_01: Thanks so much for joining us.
• 33:26
  SPEAKER_01: And don't forget to hit that subscribe button and connect with us online so you'll never miss an episode and can catch up on all the ones you might have missed.
• 33:33
  SPEAKER_01: Got a topic you're fired up about, or maybe you want to be a guest on the show?
• 33:37
  SPEAKER_01: Fred would love to hear from you.
• 33:39
  SPEAKER_01: Just reach out at S C R A N S at S T O N G E dot com.
• 33:45
  SPEAKER_01: We'll see you next time.