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How Lessons Learned as a Combat Hospital Corpsman Helped Steve Kiewiet Build a Successful Career as a Supply Chain Leader · Taking The Supply Chain Pulse

• 0:05
  Speaker 1: Hello again everybody.
• 0:06
  Speaker 1: This is Fred Kranz from St Auge here today with another episode of Taking the Supply Chain Pulse.
• 0:12
  Speaker 1: Today, our guest is Steve Kiewit, the Chief Commercial Officer at CCS Medical.
• 0:18
  Speaker 1: I've known Steve for many years.
• 0:20
  Speaker 1: We share a common background.
• 0:21
  Speaker 1: Steve, it's a real honor to have you here and I wish we had a common background.
• 0:24
  Speaker 1: Steve, it's a real honor to have here, have you here, and I wish we had a camera.
• 0:27
  Speaker 1: I wish this were a video, uh uh, podcast, because I could see your shirt, which is really cool looking so thank you.
• 0:36
  Speaker 2: I tried to compete with you know your wild pants, so I had to put something colorful on looking good, buddy, buddy.
• 0:44
  Speaker 1: So, steve, one of the things that I always start out by having people tell us about themselves, but one of the things we're going to find out today is that you and I have a unique commonality in our history, and I want to get into that because I think it's something that's lacking in many people in supply chain.
• 1:02
  Speaker 1: I think it's a big positive for us.
• 1:04
  Speaker 1: It's lacking in many people in supply chain.
• 1:06
  Speaker 1: I think it's a big positive for us, and that is the fact that we have seen healthcare from many different vantage points from caregiver to running supply chains, to being outside of the caregiving area or the provider side and seeing how healthcare looks from there.
• 1:23
  Speaker 1: So there's a lot of good conversation here.
• 1:25
  Speaker 1: So, steve, why don't you start out by telling us about yourself?
• 1:28
  Speaker 1: You know?
• 1:32
  Speaker 2: Sure, yeah, well, it's been in healthcare a long time, as you said, and it kind of started with back in high school, you know, growing up in small farming town in Northern Iowa.
• 1:43
  Speaker 2: I was on the volunteer ambulance crew as an EMT in high school and then, you know, tried to, you know, some college and ended up in the Navy, and we probably don't have enough time for the.
• 1:57
  Speaker 2: How I ended up as a corpsman isn't what I went to do, but it's what the recruiter said I needed to do and he had a great sales pitch and so I ended up going to Corman School and then, originally, I had orders to Balboa, to the Naval Hospital there in San Diego, and then, about three days before graduation, the lead instructor called me in and said hey, I'm going to teach you about two things that you haven't learned yet.
• 2:25
  Speaker 2: It's called needs of the navy and order modification.
• 2:28
  Speaker 2: So you're going to camp pendleton to fleet medical school, hoorah, so the rest is history.
• 2:36
  Speaker 2: So, uh, you know, um, and had a great time, and that's been in health care ever since, from from my time in the Navy to getting out and working as a paramedic.
• 2:45
  Speaker 2: I use the GI Bill to finish school to pharmaceutical sales was my first job after that and after paramedic and college and and right on in, you know, to.
• 2:59
  Speaker 2: What's funny is that that was great.
• 3:02
  Speaker 2: I learned a lot about what happens in doctors offices or physicians offices, and, and what was funny is I would run into these other sales reps, medical sales reps, in the, in the waiting room and they would give me a hard time about, you know, pharmaceutical being a pharmaceutical rep.
• 3:22
  Speaker 2: They're like oh, you're just a caterer, you know, and you're just bringing lunches, and when you're ready to do a real sales job, why don't you come try our company?
• 3:30
  Speaker 2: Because the doctor has to write a check for what we're selling and that's real sales.
• 3:34
  Speaker 2: And so, um, that's how I ended up at pss world medical physician sales and service, probably one of the greatest selling organizations I've ever had the chance to be a part of, which was started by the late Pat Kelly and you know you should.
• 3:50
  Speaker 2: And if you ever find their history, you can find his book faster company in some old library somewhere.
• 3:56
  Speaker 2: It's worth a read.
• 3:57
  Speaker 2: And of course they were acquired by McKesson several years ago, and great opportunity doing that.
• 4:04
  Speaker 2: And then they went from that to working for a ED manufacturer.
• 4:10
  Speaker 2: So I got to see the world from the manufacturing side of the business and and a company that only sold through distributors, so still understanding the value of distribution and and working with distributors.
• 4:21
  Speaker 2: And that's how I ended up at Cardinal Health and supporting BJC Healthcare and other businesses and I ran through a few different roles in Cardinal Health over those years and then took the opportunity to be in the supply chain team at BJC so back in the healthcare provider world and close to the patient, and a lot of amazing things happened in that organization and the chance to work with a lot of other people in a similar role and from great organizations across the United States.
• 4:54
  Speaker 2: And my time with ARM.
• 4:55
  Speaker 2: That's when I got involved with ARM and ended up being on their board and even board chair for a year.
• 5:03
  Speaker 2: So I've always enjoyed that time, you know, working with great, great thinking leaders and great leaders trying to solve complex problems in supply chain.
• 5:14
  Speaker 2: And BJC to InnoLair got to see the GPO world from a small GPO perspective, which we were then acquired, of course, by Vizient, you know, into my tenure there, which led to my current role.
• 5:28
  Speaker 2: So you know now I'm on the DME side of the world, focused on diabetes and diabetes care, also care management.
• 5:36
  Speaker 2: So we have a lot of employer groups that we manage their diabetic populations for them and so coaching and counseling and started here, been here three years, started as the chief operating officer and then in january this year took on all of the commercial responsibilities.
• 5:52
  Speaker 2: So, as the chief commercial officer, now still have all the coo job responsibilities and just added on you know sales and business development and all the commercial activity as well.
• 6:03
  Speaker 2: You know sales and business development and all the commercial activity as well, as we continue to expand our focus on helping people with diabetes, you know live the best life possible with that disease.
• 6:17
  Speaker 1: Very interesting.
• 6:17
  Speaker 1: Well, I want to focus on this because you've got a really interesting background.
• 6:23
  Speaker 1: I want to ask you the one question.
• 6:26
  Speaker 1: I'm going to leave out your first two experiences because I want to talk about those later, but I want you to tell me that in your role I'm going to name the role and then you tell me how you saw and how you interacted with the healthcare supply chain.
• 6:41
  Speaker 1: Okay, Okay, Yep, so, cause, cause, you have a perspective as a provider, as a supplier, as a GPO guy working at arms, I mean you've got.
• 6:49
  Speaker 1: You've got a really interesting thing of perspective that most people don't have.
• 6:55
  Speaker 1: So when you started out as a pharmaceutical rep did, did you come in contact with the supply chain?
• 7:00
  Speaker 1: If so, how and how did how did that look?
• 7:04
  Speaker 2: You know what was interesting in that?
• 7:05
  Speaker 2: It was a small company that made cough and cold products, and they were you know me too, you know generic products competing against your.
• 7:13
  Speaker 2: You know big name branded companies, and so, because it was small, I knew quite a bit about the supply chain.
• 7:21
  Speaker 2: So I knew the owner of the company and the contract manufacturers that he contracted with to make the pills that we were selling.
• 7:30
  Speaker 2: And then, of course, I played a role in supply chain.
• 7:34
  Speaker 2: I probably wouldn't have called it that then.
• 7:35
  Speaker 2: But you know, distributing samples, you know, is a key part of the job is, you know is is actually I'd get, you know, big shipments of medication to my house and uh, you'd package all those up for your.
• 7:48
  Speaker 2: You know, every day, going on the road, uh, to your call points at a five week schedule, and all the different doctor's offices and pharmacies you would visit and and leaving samples of products and and uh getting your signatures and all of that, and then uh, you know, turning in your orders.
• 8:04
  Speaker 2: And so that was probably the extent of my supply chain exposure there.
• 8:09
  Speaker 1: That's interesting.
• 8:10
  Speaker 1: As a pharmaceutical guy, you at least had some exposure to the supply chain.
• 8:14
  Speaker 1: If you'd have been an orthopedic rep, you wouldn't have had to worry about supply chain, because you just go talk directly to the doctors and ignore the guys right, True.
• 8:23
  Speaker 1: What about when you were a distribution ops leader?
• 8:27
  Speaker 2: So, of course, your key component of the supply chain there and at PSS.
• 8:32
  Speaker 2: Pss, at that time it was a very entrepreneurial model.
• 8:36
  Speaker 2: They had distribution centers all across the US and each of those ran almost like as a franchise business or an independent business.
• 8:44
  Speaker 2: So they had a sales leader and an operations leader and the two of you really ran the business of that distribution center.
• 8:52
  Speaker 2: So you had your own purchasing department, you had your own AR and AP department, your own customer service, you had your sales force and then your operations teams and then your delivery drivers.
• 9:03
  Speaker 2: So one of the things that set PSS apart was at that time when, you know, pat started the company.
• 9:09
  Speaker 2: It was just big medical distributors that would drop off pallets of product, but a physician office needed one of something or a bag of something, you know, a box of tongue depressors, not a case or not a pallet, and so we would break all that down and then we would do hand deliveries.
• 9:25
  Speaker 2: And you know, one of the things I remember is when I, you know, I got hired as an operations leader, but part of the training was I had to work as a delivery driver for a while.
• 9:34
  Speaker 2: I had to work collecting money for a little while I had to work in you know the purchasing, so you knew all the different aspects.
• 9:41
  Speaker 2: So I remember you know delivering supplies, the doctor's offices, and so we would get all our shipments in to the distribution center and then every day we'd send out our delivery vans out to the doctor's offices and delivering their orders and of course the sales team is calling on those offices putting those orders in.
• 9:59
  Speaker 2: And so very close to the supply chain, because we were on the ordering side, the delivering side and dealing directly with you know physicians' offices and their needs.
• 10:13
  Speaker 1: Interesting.
• 10:14
  Speaker 1: So I always got a kick out of the physicians, the products that the physicians would use compared to what they wanted in the hospitals.
• 10:21
  Speaker 1: You know, when we I was at Covenant in Waterloo, iowa, and we took over a bunch of clinics and my assumption was that we just put all the doctor's offices on what we were using and get rid of the variation and they all got ticked off because the stuff that we were using, that they demanded in the hospital, was more costly than the stuff they were using in their own offices of course you were for sure, you know, you know, and back then, um, you know, a lot of primary care physicians or just physician offices of all different types were very independent.
• 11:00
  Speaker 2: right, it was a doctor and it was a business for them and they owned it and and and you know, and sometimes when you were collecting money for you know from them that were, you know, sometimes you're collecting from the doctor's wife who was the office manager sometimes, but but it was their business, right, and so they were very aware of cost and reimbursement and the ability.
• 11:22
  Speaker 2: You know what it took to keep a business functioning reimbursement and and the ability.
• 11:26
  Speaker 1: You know what it took to keep a business functioning, yep.
• 11:27
  Speaker 1: So eventually I'm gonna, uh, I'm gonna skip over your national accounts manager thing.
• 11:30
  Speaker 1: But eventually you transition to cardinal health and and uh.
• 11:34
  Speaker 1: So you were the big distributor.
• 11:36
  Speaker 1: I mean, I remember back in 1997 or 98 we did a big project at bjc and you know, cardinal Health was running the place, uh, servicing them from what?
• 11:48
  Speaker 1: Earth City, I think it was um and um, and that was a unique relationship.
• 11:55
  Speaker 1: The one thing that, as a supply chain leader, I always I didn't realize this until really late in my career I never talked with, uh, with supply chain people from the distributors or from anyone else.
• 12:09
  Speaker 1: I was always talking to sales reps and it's different.
• 12:13
  Speaker 1: You didn't learn anything about the supply chain talking to the sales reps.
• 12:16
  Speaker 1: You didn't understand things.
• 12:19
  Speaker 1: So how did Cardinal, how did your role look at Cardinal, when you're working with Jim Francis or those guys at BJC?
• 12:28
  Speaker 1: How did you approach working with the supply chain then?
• 12:32
  Speaker 2: Yeah, jim was at Mayo by then but Nancy LeMaster was.
• 12:35
  Speaker 2: So in my original my first role at Cardinal Nancy LeMaster, great human being and great supply chain leader was head of supply chain then and my role was with the IPS I don't even know if that still exists at Cardinal anymore team supporting BJC and supporting the work that Cardinal was doing for BJC.
• 13:02
  Speaker 2: That's where I got my black belt training.
• 13:04
  Speaker 2: So I became a Link Sigma black belt and worked on projects to streamline and improve how all of the business that BJC did with Cardinal and Cardinal.
• 13:16
  Speaker 2: So if you imagine from a customer perspective, a BJC perspective, it can get convoluted sometimes when you're dealing with value link and distribution and pharmaceutical and pre-source and the specialty matters.
• 13:34
  Speaker 2: Cardinal was providing probably a dozen different services and they weren't all coordinated well.
• 13:40
  Speaker 2: So I became kind of the quarterback role, kind of helping coordinate all of those different cardinal divisions and the things they were doing with BJC and the BJC supply chain team.
• 13:51
  Speaker 2: And that's where you learned a lot just on how complicated meeting the needs of a large, you know, a large, successful healthcare organization and especially one the size and complexity of a BJC and the Cleveland clinics and Mayo clinics, all of those right.
• 14:09
  Speaker 2: They just their demands are heavy.
• 14:10
  Speaker 2: The needs just to run their business is heavy.
• 14:13
  Speaker 2: You know, just as an example, I think, barnes, jewish, the big hospital, you know it was probably when I was there three, four tractor trailer loads a night.
• 14:25
  Speaker 2: You know, supplies just to, you know, to keep their business going.
• 14:30
  Speaker 2: So it's complex, and learned a lot in that role about what distributors do, what happens in hospitals and health care and the support that they need, which then led to, you know, I took on a role at Dublin for a little while working in the category management team where you learn about product management, supplier relations, category management, which then led to me going back and running the distribution center in Hearst City as the DO.
• 15:01
  Speaker 2: And that was when Hearst City also had the National Suture Center, so we were doing also all wound closure products for all 50 states out of there.
• 15:14
  Speaker 2: At that time Azair kind of did set that up as a competitor to Suture Express and so ran that business as well.
• 15:23
  Speaker 1: So that's interesting.
• 15:24
  Speaker 1: So after Cardinal, you jumped to the provider side and I would right straight to BJC.
• 15:33
  Speaker 1: I would ask you how did what you learned at Cardinal give you insight in what needed to be done at BJC?
• 15:46
  Speaker 2: But it gives you a lot of insight because you understand the needs of the system, you understand the amount of work it takes to to their spend and related to you know the cost of.
• 15:54
  Speaker 2: You know their supplies and supply chains.
• 15:56
  Speaker 2: We all know labor and stuff is your most expensive things in a health care organization and as a part of that, that's when they really started their transformation journey, which led to, you know, me joining the team and some other people joining the team and really transforming that from a materials management department, if you will, to a true integrated supply chain organization and being a part of that journey with you know Nancy and Doug Pitnitsky and Ron Shelley and many, many we could talk forever about all the amazing people there that were part of that journey to really start to bring discipline to product decisions, to value analysis, you know value analysis to finding new and more innovative and better ways to deliver all the needs of the healthcare organization but also manage our resources well, you know and be good stewards of the money that we spend and where we spend it to deliver high value care.
• 17:29
  Speaker 1: I know that you got into a lot of operational stuff too.
• 17:33
  Speaker 1: I mean, I think you were probably one of the first guys to.
• 17:38
  Speaker 1: Operations is pretty much overlooked by most supply chain leaders and you had a distinct experience and understanding of operations.
• 17:47
  Speaker 1: So what operational improvements did you make at BJC because of what you'd learned at Cardinal?
• 17:53
  Speaker 2: Oh, so we put a lot of.
• 17:54
  Speaker 2: So I kept my black belt hat on, if you will, and so we did a lot of black belt projects throughout the operations organization.
• 18:04
  Speaker 2: So, if you imagine, we put a lot of focus into what we call dock to stock, right so from the loading dock to the supply room, and we evaluated a lot of different innovations and technologies to do that, from the automated guided vehicle robots we put in when they built the new tower toward the end of my time there at BJC, to good harm management skills or tools to Kanban systems and other ways to simplify how we get the product, the right supply, to the right location at the right time and the right quantity so we don't have too much and we don't have too little.
• 18:49
  Speaker 2: So we don't have too much and we don't have too little.
• 18:51
  Speaker 2: And actually we won a Gartner Supply Chainovator Award during that time for some of that work and then, as well as the corresponding work around putting a lot more discipline into our value analysis groups and things like that.
• 19:08
  Speaker 2: But it was probably more black belt projects and green belt projects than I can even remember that we did with our teams and we trained everybody on you know just how to you know.
• 19:21
  Speaker 2: Think lean, operate lean, find ways to do better, do faster, do more efficient, to drive high service.
• 19:29
  Speaker 1: Interesting, and then you went to the dark side the dark side, yep uh, was it into layer, called into layer when you got there, or was it still a marionette?
• 19:39
  Speaker 2: it was into layer when I got there.
• 19:41
  Speaker 2: I think the name change was a two or three years before I got there, but but still ever, even now, I into somebody and they still called it a manhunt.
• 19:51
  Speaker 2: So it's hard.
• 19:52
  Speaker 2: Sometimes it's name changes.
• 19:54
  Speaker 2: Branding changes are hard.
• 19:57
  Speaker 1: What did you learn about the GPOs that you didn't know before you went to work for a GPO?
• 20:07
  Speaker 2: You know, what was interesting is all of the things that go on unrelated to the contracts, right, and so the contracts and the admin fees, all that kind of stuff is such a small portion of what your customers really need.
• 20:27
  Speaker 2: Yes, aggregation, and I mean there's value in that, but but it was really when you would go out and spend time with your clients and your, your health systems that were your members and those executives and those teams and looked at what problems they're trying to solve, it really became clear that that, yes, contracting is a big component, um, and it does drive, you know, a certain amount of revenue.
• 20:53
  Speaker 2: But but really it's in in data, it's in, it's in comparative data, it's in services, it's in, um, you know even things like I did at bjc, like, like the ability to come in and help us do process improvement or help us do service improvement or help us look at specific categories of opportunity and tie inside our spend and help us understand our spend and benchmark our spend.
• 21:22
  Speaker 2: You know, and some of that you know, learning, you know also tied into you know, a lot of the work that you know I kicked off at ARM around the ARM Keys program right to again find a way to give health systems an opportunity to really understand their data and how it compares to other people that they would compare themselves to and benchmark against, because it's not like the retail world where there's just a lot of benchmarking data readily available.
• 21:53
  Speaker 2: Data standards was another one we spent.
• 21:57
  Speaker 2: You learn that there's a huge especially on the GPO side.
• 22:00
  Speaker 2: You learn how disconnected healthcare is on the data side of the world and data standards and data flows and data availability and so, which hinders a lot of your ability to do good comparative data and analysis or even interpretive data and analysis.
• 22:20
  Speaker 1: Very, very good.
• 22:21
  Speaker 1: Now you've made it to home healthcare.
• 22:25
  Speaker 1: Yes, what?
• 22:27
  Speaker 1: How is that different from everything you knew before you got there?
• 22:32
  Speaker 2: well, um, it's.
• 22:34
  Speaker 2: It's interesting in that on the on the one side, I have way fewer skus than I deal with.
• 22:41
  Speaker 2: So, so, and and everything is direct from the oems in this world.
• 22:49
  Speaker 2: You know, we did, especially in the diabetes world, specifically when you get into like ostomy, urology, wound care and some of those, and there's some distributors we can work with and and all of that.
• 23:00
  Speaker 2: But you work a lot in the OEM world and then it's all, it's.
• 23:04
  Speaker 2: Everything's about last month, right, because you're to the home and to the patient's home and then all of the unique intricacies of getting patients the stuff that they need where they need it, when they need it.
• 23:18
  Speaker 2: Especially, we have a large Medicare population and a good portion of that population doesn't stay at the same address for a full year.
• 23:28
  Speaker 2: So they'll spend part of the year maybe down south and part of the year, you know, maybe staying with some of their kids and part of the year at their home base and so keeping up with all of those address changes and staying in communication and connection.
• 23:45
  Speaker 2: It's a very people connection business.
• 23:47
  Speaker 2: So, you know, have a large call center staff and we reach out and talk to you know, phone, text, email.
• 23:54
  Speaker 2: We communicate regularly with all of our patients.
• 23:57
  Speaker 2: You know one, because they have to authorize their next shipment and for us to send their next shipment and to bill their insurance, and so you know then that's a CMS requirement.
• 24:08
  Speaker 2: So you know, in many ways what I've enjoyed about this is I've never been as close to the patient ever.
• 24:16
  Speaker 2: Like you'd see a lot of patients in you know the BJC world and you could go do rounds and see patients and meet patients and meet caregivers who take care of patients.
• 24:26
  Speaker 2: But here we're literally talking to the patients on a regular basis.
• 24:30
  Speaker 2: You know, in some cases you know if you're on a, if you're on, if your policy is on a 30 day supply, so we'll talk to you 12 times a year.
• 24:39
  Speaker 2: You know they don't talk to their doctor that much, so it's so you're very close.
• 24:46
  Speaker 2: And then when you talk to our agents who are on the phone, you know they hear a lot of the frustrations that our patients deal with in the disconnectedness of healthcare, like their endo isn't connected to their PCP, who isn't connected to their heart doctor, who isn't connected to their.
• 25:07
  Speaker 1: You know you name it.
• 25:09
  Speaker 2: And trying to manage all of that disconnectedness.
• 25:13
  Speaker 2: You know you just hear about it and you wish you could find solutions for everybody.
• 25:17
  Speaker 2: And so you know I don't work on supply chain very much, but we work a lot on service.
• 25:23
  Speaker 2: You know we're in a service business and you know, on this side, where it is all about service and supplies and billing and getting the bills right and getting people the supplies that they need, and of course, you have a chronic disease, you have something that isn't going to go away, and so you need those supplies, whether it's you're on an insulin pump or you're on a continuous glucose monitor or you know using a blood glucose monitor, and then it's, you know, missing something or getting delayed in something.
• 25:54
  Speaker 2: It just can't happen.
• 25:56
  Speaker 2: It's like its own set of never events.
• 25:58
  Speaker 2: If you will right, when your sensor's up, your sensor's up, you need to put a new sensor on or you need to change your tubing or your reservoir.
• 26:09
  Speaker 2: That can't not happen.
• 26:13
  Speaker 2: And so a lot of shipments going out every day.
• 26:18
  Speaker 2: It's fun.
• 26:20
  Speaker 2: I think last year we did 1.3 million shipments, something like that.
• 26:25
  Speaker 2: All small, all small, yes.
• 26:30
  Speaker 1: Here's a question related to that.
• 26:32
  Speaker 1: You know everybody well.
• 26:35
  Speaker 1: Many of the big IDNs want to do everything.
• 26:37
  Speaker 1: Do you think that they are organized and good enough to do home health care correctly?
• 26:46
  Speaker 2: That's a great question, yes and no.
• 26:52
  Speaker 2: So yes in that probably most of the endocrinology offices we call on, or the high or the private, the PCPs that we call on, who have a high diabetic practice and are writing a lot of insulin, probably most of them or a few of them, are truly independent anymore and they're probably connected in some way to a health system.
• 27:14
  Speaker 2: So the care is connected to the health system, um, but the complexity of and setting up a small box operation is just way different than I mean even for the health systems that have gone on and gone.
• 27:30
  Speaker 2: You know taken over their own distribution and do self-distribution, and there there's a list of them out there and they're all doing, you know doing.
• 27:35
  Speaker 2: You know taken over their own distribution and do self-distribution, and there's a list of them out there and they're all doing.
• 27:37
  Speaker 2: You know doing.
• 27:38
  Speaker 2: Well, you know from what you read and see about them.
• 27:41
  Speaker 2: I haven't really toured any recently but you know bringing in bulk, a big bulk, and breaking it down for yourself, still on probably fairly large vehicles to one point is different than a large small box operation right where you're really relying on FedEx and UPS and all of that and the billing complexity is the billing you know.
• 28:09
  Speaker 2: So, yes, you could do it, but they would have to invest in some staff, you know that have just a different set of skills than what they have today.
• 28:19
  Speaker 2: So RCM for DME is very different than RCM for inpatient or even outpatient.
• 28:25
  Speaker 2: So different set of rules, different set of, you know, and so it's just putting you know, if you hire the right teams, you make the right investments, could they do it?
• 28:33
  Speaker 2: Yes, Interesting or buy a DME company, right you?
• 28:39
  Speaker 2: could do that I mean there are health systems that do DME really well, but it's more of the local, what I call full-service bent metal DME, right?
• 28:50
  Speaker 2: So I mean BJC even has a home health division, but it's specific to their geography and a lot of home delivery, home oxygen, you know those types of things, and so there are health systems that do it and do it well.
• 29:04
  Speaker 2: When you get into some of the things like diabetes and the chronic care, just it's different, adds a complexity to it, and then would they want to do it, for the margins that exist in that world is a whole nother over the ballgame.
• 29:24
  Speaker 2: It's not like everything in healthcare the manufacturers control the costs, the payers control the reimbursement rate, or the government, you know, depending on who you're.
• 29:34
  Speaker 2: You know Medicaid, medicare, and the margins are the margins, and so can you put an operation together that can work in the margin.
• 29:44
  Speaker 1: So they just can't jump into this naively.
• 29:46
  Speaker 1: Is what you're saying?
• 29:47
  Speaker 1: You got to know what you're getting into, sure, okay.
• 29:51
  Speaker 1: Now the last area I want to talk about, and this is I probably have trouble with this, okay.
• 30:01
  Speaker 1: Okay, of all the things in the world, when I leave this world, that I'm going to be proudest of, there's one thing, and that's being a Corbin.
• 30:14
  Speaker 1: Yeah, tell us about that.
• 30:18
  Speaker 2: Man, it's just, you know, I mean, you go through the training, you don't realize it until you actually get to your first unit and spend time in your first unit and then after that and you get, especially as an FMF corpsman.
• 30:31
  Speaker 2: I'm going to go from that Like there's nothing like being doc to a group of Marines, right, and like, um, how much they, how much crap they give you and yet how much they would do they would die on a Hill for you and you do the same for them.
• 30:48
  Speaker 2: I mean, in the time you spend just taking care of people from and it's little things, right.
• 30:54
  Speaker 2: I mean I mean you become an expert at blisters and foot care and you know cause feet will kill an army, right, like if you can't be mobile, uh, you, you're not getting anywhere, right, and so, um, but it but it's those little things you know.
• 31:10
  Speaker 2: And and you take care of your Marines.
• 31:12
  Speaker 2: You know it's like taking care of your patients and you help them be in their best fighting shape possible and then when things go wrong, you're there to deal with it and you do it.
• 31:22
  Speaker 2: You just do what you're.
• 31:23
  Speaker 2: You know the training kicks in, but the amount of like still, to this day, my best connections are people from that period of my life.
• 31:34
  Speaker 2: My best connections are people from that period of my life and some of my best memories, some of the best humans I ever worked for, and with Some of the worst too, like you know.
• 31:50
  Speaker 2: But there's always that.
• 31:51
  Speaker 2: But you know it's.
• 31:52
  Speaker 2: I mean a group of Marines paid for my tattoo.
• 31:55
  Speaker 2: That's a Marine Corps emblem.
• 31:57
  Speaker 2: You know the caduceus in the middle of the globe and says Doc Kiwi, they paid for that.
• 32:04
  Speaker 2: You know, because you know we can't.
• 32:07
  Speaker 2: You know had a went out on a deployment and everybody came home in one piece.
• 32:12
  Speaker 2: And everybody came home in one piece and you know it's.
• 32:25
  Speaker 2: You know you go out and you do that work and you're basically you're there to focus solely on other people's survival versus your own, and it's the ultimate service role, I think.
• 32:40
  Speaker 2: Anybody that's a combat medic.
• 32:41
  Speaker 2: You know the Army equivalents and the Air Force, all those guys I mean.
• 32:46
  Speaker 2: Fmf is still the best and I will always treasure that time.
• 32:52
  Speaker 2: But you know, every day you give the middle finger to death.
• 32:56
  Speaker 1: Yeah, you know it's interesting because once you've been with the Marines you're sort of not a Navy guy anymore.
• 33:06
  Speaker 1: Right, and really I'm serious.
• 33:10
  Speaker 1: I mean, the proudest thing in my life was that you walked down the street knowing that you were good enough that to become even the average us navy fleet marine force hospital corpsman is at the top, at the top, at the top.
• 33:27
  Speaker 1: You know, yeah, that's just my opinion and but what I wanted to say about that, that's a a really overlooked thing, and I talked for a second or two before we started.
• 33:37
  Speaker 2: Yeah, sure.
• 33:38
  Speaker 1: In Vietnam.
• 33:39
  Speaker 1: There were 58,148 troops killed.
• 33:43
  Speaker 1: There were 304,000 people wounded and of the wounded, only 5,299 died of their wounds.
• 33:54
  Speaker 1: That is 1.7%.
• 33:57
  Speaker 1: And that's when I learned the value of logistics.
• 34:01
  Speaker 1: The one thing that the military had was you and I at the point of injury.
• 34:07
  Speaker 1: Stabilized dude.
• 34:09
  Speaker 1: We got him on a Huey or a CH-47 or whatever is coming into land and they took them to the next place, and the next place could be a collecting and clearing platoon uh, in my case in caisson or fubai or dongha.
• 34:22
  Speaker 1: That would stabilize them further, do more treatment and then get them on a flight to either denang or maybe to the philippines, or even to yukuka, japan, and got them home.
• 34:35
  Speaker 1: That's how 98.3% of the people that got wounded made it.
• 34:40
  Speaker 1: Can you talk on that a little more?
• 34:43
  Speaker 2: Sure, I mean everything's about logistics.
• 34:47
  Speaker 2: When you get to the end right, I mean you think about it.
• 34:50
  Speaker 2: I mean that's patient logistics, wounded patient, critical patient logistics, which is hugely critical and the stats, you there bear that out and I think it's something they continue to this day.
• 35:03
  Speaker 2: I mean the innovations you heard coming out of you know 20 year war on terror.
• 35:07
  Speaker 2: You know similar opportunities where the more definitive care you can give immediately and then stage people along.
• 35:16
  Speaker 2: But you know, when I take that and think about in the bigger health care supply chain or just health care in general, at the end everything is about logistics.
• 35:25
  Speaker 2: You need to get patients to the right places to have work done.
• 35:30
  Speaker 2: Supply has got to move and be in the right place to be available for when the care is done.
• 35:36
  Speaker 2: And everything is about movement.
• 35:39
  Speaker 2: You know, and people spend an enormous amount of time on on.
• 35:44
  Speaker 2: You know the buying and the negotiating and the picking, what should we use.
• 35:49
  Speaker 2: And you go to the conferences and you hear a lot of work.
• 35:52
  Speaker 2: You know we'll sit through days of conferences on amazing things people are doing on all those areas.
• 35:58
  Speaker 2: I always note that I don't hear many talk about things we're doing to make the movement better Like, how do you improve the movement of a patient through a hospital, right?
• 36:10
  Speaker 2: How do you improve the movement of supplies from the manufacturer to your self-distribution or your distribution partner to your dock, to your storeroom, from the storeroom to the treatment area?
• 36:24
  Speaker 2: You know, that's all of that.
• 36:26
  Speaker 2: All of that is, you know, time spent doing that is not caregiving time or value-added time for anybody, right, and you'll never get it to zero.
• 36:35
  Speaker 2: But you know, if you can find ways to improve movement, especially when we're going to start going to care at the home, health care in the home, that's a whole other set of logistics which, if you don't do that well, product gets destroyed, product gets lost, it gets too hot or it's, you know, especially when you deal with some of these wound care supplies and medications and drugs and things like that, and also your staff movement, right.
• 37:11
  Speaker 2: So I mean you know how do you get your staff into the right place with the most efficiency and so that they're always, you know, rested and ready and ready to go.
• 37:20
  Speaker 2: You know which the military has learned that you know very well in getting large amounts of people deployed into various places to make things happen.
• 37:31
  Speaker 2: But it just, it always dawns on me.
• 37:34
  Speaker 2: You never hear people do very many presentations on logistics.
• 37:37
  Speaker 2: No, and at these conferences, that's because.
• 37:43
  Speaker 1: That's because, as a guy from St Louis, yogi Berra, once said about baseball.
• 37:48
  Speaker 1: He said he said baseball is 90% metal, the other half is physical and and most people don't understand that supply chain is 90% political and the other half is logistics.
• 38:09
  Speaker 1: I get it Anyway, steve.
• 38:13
  Speaker 1: It's been so great having you here, my brother once a corpsman, you're always a corpsman.
• 38:22
  Speaker 1: We walk at a different height than the rest of the folks and we do.
• 38:28
  Speaker 1: I'm serious, and what you said earlier.
• 38:30
  Speaker 1: I admire all the other medics out there from the other branches of the services, but if you haven't been with the Marines, you haven't been with the real thing.
• 38:38
  Speaker 1: That's the way I see it.
• 38:39
  Speaker 1: Steve, thanks again for being on the show.
• 38:42
  Speaker 1: Hope to talk to you soon.
• 38:44
  Speaker 1: See you at RM this year and, oorah, take care brother have a good day.