Geisinger Health System
Enterprise Supply Chain Services
Strategic Overview
SEPAC Meeting
March 17, 2015
Deborah Petretich Templeton, R.Ph., M.H.A.
Chief, Care Support Services
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The Legacy
“Make my hospital right,
make it the best.”
Abigail Geisinger
1827-1921
“Geisinger Quality – Striving for Perfection”…
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Geisinger Health System
Mission
Enhance the quality of life through an integrated health
service organization based on a balanced program of
patient care, education, research, and community
service.
Geisinger Brand
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Quality
Value
Partnerships
Advocacy
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GEISINGER–An Integrated Health Services Organization
Provider
Facilities
$1,854M
Physician
Practice Group
$835M
Geisinger Medical Center &
Geisinger Shamokin Area
Community Hospital
Multispecialty group
Geisinger Wyoming Valley
Medical Center
~1,040 employed
physicians
Geisinger Community Medical
Center
Geisinger Bloomsburg Hospital
Geisinger Lewistown Hospital
Holy Spirit Hosp. Harrisburg (not
inc in stats)
2 Nursing Homes
4 Surgery Centers
87K admissions/OBS & SORUs
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Geisinger Health
System 2013
1,746
beds
~710 advanced
practitioners
83 primary & specialty
clinic sites
~2.5M clinic outpatient
visits
~410 residents & fellows
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Managed
Care Companies
$2,093M
~463K members
(including ~77K
Medicare Advantage
members)
~112K Medicaid
Managed Care Projected
Membership (GHP
Family)
Diversified products
~37K contracted
providers/facilities
43 PA counties
Members in 4 states
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Transforming Healthcare with Technology
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> $190 M invested (hardware, software, manpower, training)
Running costs: ~4.6% of annual revenue of > $3.6 Billion
Fully-integrated EHR: 49 community practice sites; 5 hospitals; 4 EDs; 4 Surgical
Centers; 14 CareWorks retail-based and worksite clinics, walk-in clinics and after hours
clinics
– Acute and chronic care management
– Optimized transitions of care
Networked Patient Portal - ~234,000 active users (40% of ongoing patients)
– Patient self-service (self-scheduling, patient-entered data)
– Home monitoring integrated with Medical Home
“Outreach Health IT” – 6,461 users in 812 non-Geisinger practices
– Remote support for regional ICUs
– Telestroke services to regional EDs
Active Regional Health-Information Exchange (KeyHIE)
– 19 hospitals, 100+ practices, 634,000 patients consented, publish 600,000+
documents monthly, participants access 900+ patients monthly
e-health (eICU®) Programs
Keystone Beacon Community
– HIT-enabled, Community-wide care coordination in 5 rural counties
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GHS awarded “Most Wired” health care system by Computer World eleven years
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Challenges (National)
• ACA
• Medicare Advantage (Less Revenue)
• Expanded Medicaid Managed Care (Less Revenue)
• ? Price Controls
• ? Regulatory Commissions
• Multiple Payment Incentive Experiments Plus Residual
FFS
• Continued Provider/Payer Consolidation (And Political
Push Back)
• Global Budgets for Medicare & Commercial Payer
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SUPPLY CHAIN STRATEGY
GHS Supply Chain Services Mission:
“If we do our job, you’ll never have to do our job.”
- Deb Templeton, Chief Care Support Services Officer
Goals:
Efficiency in Process
Reduce the “supply burden” from clinical care givers
Service Targets:
“Externalize” the Supply Chain
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Work from patient backwards; clinical collaboration
Recognize change to caring for Communities
Focus on Care Management, not Care Delivery
Expand Inventory Oversight and Optimization
Optimize Supply Chain efficiencies
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Geisinger Health System
Supply Chain Services
Organization Chart
Chief Operating
Officer (COO)
Chief Care Support
Services Officer
Administrative
Assistant
Associate VP,
Procurement Services
Purchasing
Vice President,
Enterprise Supply
Chain Services
Director, Clinical Use
Evaluation (CUE)
CUE
Regional Director,
Supply Chain
Logistics
Central/West
Regional Director,
Supply Chain
Logistics Northeast
Logistics
Logistics
Strategic Sourcing
Patient Transport
Patient Transport
Contracting
Linen
Linen
Equipment Planning
Mailroom
Mailroom
CSR (GCMC only)
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CY 14 Purchasing Volume
198,674 Purchase orders
695,998 Purchase Order Lines
$580,291,500 spent on PO’s
(approx. $135M Capital, $445M Expense)
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TRANSFORMATION
From a “Supply Chain”
to
Supply Flow: “PIPE”
“Process Innovation, Perfect Execution”
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OUR PIPE
Variation
INTAKE
Data Info & Process Improvement
Education & Compliance
SUPPLY
CHAIN
SERVICES:
FUTURE
STATE
Variation
Core Process
CLINICAL USE
ENGINEERING
Product Product /
Resource
Variation
Variation
Core Process
Data Info & Process Improvement
Education & Compliance
RESUPPLY
CENTRALIZED
LOGISTICS AND
MATERIALS
Right Place
(Prior to Consumption)
Variation
Variation
Core Process
Data Info & Process Improvement
Education & Compliance
USE
HEALTHCARE
ENABLED
LOGISTICS
PROGRAM
Point of Need /
Consumption
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Changes Focus
• Variation
• Awareness to
Action
• Pipe Strength
• Education &
Compliance
• Data Information
& Process
Improvement
• Flow
• Strengthen Core
Processes
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Clinical Use Evaluation/ Engineering
CUE is a structured interdisciplinary system-wide process to review all aspects of
product utilization, product selection, new product choices, product formulary
development, and cost effectiveness
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Clinically driven selection and utilization management of supplies
Staff education and involvement in the selection process
Development of a product formulary while achieving best contract pricing
Select products that enhance patient safety and strive for excellent outcomes
Product analysis is a comparative effectiveness review (both clinically and financially)
Strategic Positioning:
• Improve speed of change and maximize agility
• Enhance network visibility (both globally and locally)
• Utilization of quality methodologies (lean management, lessons learned from
industry)
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Supply Chain Services: Strategic Sourcing
SCS Mission: If we do our job, you will never do our job!
ELITE
Explain, Look, Identify, Task, Enable.
Established to create a process for multi-disciplinary review of key OR procedures to potentially produce
operational efficiencies and cost savings opportunities.
Explain the Process
1.Identify Goals, anticipated action plans and
projected outcomes
2.Data collection process
3.Understanding data limitations
4.Establish confidence
Task Shareholders to Review
1.Encourage peer-to-peer discussions relative to
practice variation
2.Utilize best practice / best outcome data to create
standards of care
3.Identify / strategize ways to overcome elephants
in the room
Look at Current Day
1.Analyze procedure volumes
2.Understand baseline costs per case
3.Identify key physician stakeholders
Enable Change
1.Provide operations the tools necessary to
facilitate change
2.Review progress and hold players accountable
Identify Opportunities
3.Report out on successes / obstacles
1.Variation in OpTime utilization, Preference cards, 4.Encourage use of the CDIS OR Dashboard tools
and Pharmaceutical utilization
to continue work post report-out
2.OpTime waste entries
3.Operational efficiencies
4.Reimbursement review
5.Clinical and operational metrics
6.Contracting opportunities
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Centralized Logistics and Materials
• Central warehouse which serves all GHS facilities
• Services being considered for consolidation include:
o Supply Chain Operations – Receiving, put-away, picking, delivery/cross-docking, shipping
of med/surgical supplies and pharmacy bulk and unit doses
o Pharmacy operations- Bulk repack, IV clean room, compounding, and retail & mail order
fill
• Benefits to include:
o Increased labor productivity
o Uniformity and control of processes
o Reduction in inventory distribution costs and improved manufacturer pricing
o Inventory visibility across the supply chain
Strategic Positioning
• Bring more inventory into ‘control’
• Enhance tools to monitor
• Transform Unknown (Stock/Non-Stock, Par/Non-par, Inventory/Non-Inventory, Owned/Non-owned) to
Known (In Inventory, In Bill of Material, In Control)
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Project HELP: Healthcare Enabled Logistics Program
Applying process engineering principles to improve Care Delivery support
Introduction
Project Overview
Project HELP aims to give back
clinical
time
to
nursing
by
engineering improved methods to
support the delivery of care. A work
sampling study performed at GMC,
which studied all inpatient areas and
the ED, found that nurses, on
average, spend 19.8% of their time
with logistics related tasks. This
includes activities such as searching
for, walking to get, and calling for
needed supplies and equipment.
HELP has 3 key focus areas. First,
we are engineering better Support
Service processes to provide better
service to the clinicians being
served. The focus of this work is to
design a support service system
which breaks down the current silooperations of departments and
works to create an integrated,
coordinated,
and
collaborative
support system.
Second, we are developing an IT
tool (BOR) which will allow us to
capture the knowledge of nursing as
it relates to resource requirements.
In this way, we will be able to
provide better service to nurses by
knowing what they need and how it
needs to be prepared in order to
provide patient care.
Lastly, we are developing a new
staff role which will provide frontline
care delivery support. Our current
system has a gap between Support
Services and nursing, which often
requires clinicians to perform the
final steps of Support activities. This
role will perform the Support tasks,
such as supply retrieval, and allow
nurses to spend more time with
patients and perform tasks which
fully utilize their skill set.
Motivation
Project Goals: Remove clinicians from Support Service tasks by improving processes,
delivery methods, and frontline interactions. Eliminate waste from the processes by
applying engineering principles and tools.
We are working to make this…
… become this.
GMC work sampling study of inpatient units and the ED.
Nonclinical
6.1%
Nursing
Practice
63.7%
Logistics
19.8%
Delivering Traveling
4.5%
3.9%
Other
Looking/
Logistics
retrieving
2.5%
2.9%
Waiting
6.0%
Unit-related
functions
1.9%
NVA Opportunity
8.4%
Chart: How nurses spend their time.
Support Services Redesign
The Bill of Resources (BOR)
Frontline Care Delivery Support
Increasing logistics efficiencies and
effectiveness to improve customer service and
remove waste in order to redeploy resources to
the frontline of care.
Using technology to enable support services to
know what is needed, when it is needed, and
where it is needed.
Bridging the gap between Support Services
and the frontline of care.
• Redesigning how deliveries are
performed and improving
departmental processes
• Removing waste from our
departments so that we can move
freed resources closer to the
frontline
• Becoming a cooperative,
integrated Support Service group
• Involving stakeholders from other
departments as we progress and
working closely with frontline staff
 Linen
 Storeroom
 Equipment
Transport
 Mail
 EVS
 Food
Services
 Pharmacy
 Blood Bank
 Patient
Transport
 CSR
 Lab
• A Bill of Resources (BOR) is a list of the supplies
and equipment, and the quantities of each, needed
to perform a care activity (similar to OR Preference Cards)
• This tool will help close the knowledge gap between
nursing and support services
• Allows support staff to be able to collect and
prepare all needed resources prior to their use
• Helps remove clinicians from logistics tasks
• This is a new role being developed which will
provide point-of-use support to clinical staff
• Bridges the gap between Support Services and
frontline of care
• Responsible for communication with Support
Service staff/departments and distribution of
supplies and other resources to clinical areas
• Performs non-clinical tasks which support the
delivery of care, in-order to give time back to
nursing staff for improved patient care
• Performed an initial 4-day pilot study on an inpatient unit with positive results
The HELP Team
What have we done so far?
• Developed a computer simulation
model of all pickup and delivery
activities in GMC which is used to
test improvement ideas
• Have worked to re-engineer processes and delivery
methods for linen, storeroom, mail, equipment
transport and food services
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SC Process
Engineers:
Kris Heimbach
Aaron Homiak
Seth Hostetler
John Pulaski
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Steering Committee:
Kevin Capatch
Kathleen Chapman
Mark Erath
Crystal Muthler
Deb Templeton
Dr. Ken Wood
Nursing Advisory
Council:
Terri Bickert
Gavin Claycomb
Kim Kuhn
Greta Rosler
Dawn Troutman
Could this…
Why is my meal
taking so long?
Current state of
logistics flow in
our facility
Patient Rooms
I need to do these
tasks for patient
care today.
Where are
the items I
need!?!?
I need (…). Where is my
nurse anyhow? I’ve been
waiting forever.
I need this
right now!!
Unit/Clinic Deliveries/Pickups
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…and this…
Nonclinical
6.1%
Delivering
3.9%
Nursing Practice
63.7%
Logistics
19.8%
Traveling
4.5%
Looking/
retrieving
2.9%
Other
Logistics
2.5%
Waiting
6.0%
NVA Opportunity
8.4%
Unit-related
functions
1.9%
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…become this….
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…and possibly this?
Nonclinical
6.1%
NVA Opportunity
8.4%
Nursing
Practice
83.5%
Unit-related
functions
1.9%
We believe it
can and will!
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Supply Chain Services: Strategic Logistics / Care Support
SCS Mission: If we do our job, you will never do our job!
RTLS – Real-Time Location System
QSight
Expanding the capability of the TeleTracking XT platform by
adding a RTLS to track critical resources and patients.
QSight is rapidly becoming the tool of choice for procedure tracking
and inventory management in our specialty operatory areas. The
Owens & Minor product is web hosted and has proven to be easily
integrated to Lawson, ADT, and other applications
•Our processes demand mobility, but until
this investment, there was no system
capable of managing the flow of
resources from use to re-use or for
tracking patients through the ED and the
OR
Above: A beacon
that tracks the tags
•RTLS has three key components: Tags,
Beacons, and Collectors
Below: A tag
attached to an IV
pump
•Beacons expose the tag to Infrared (IR)
light so exact positioning can be tracked
•Tags broadcast their location in real-time
to the collector
•Current Coverage
•GMC
•GWV
•GCMC
•Note : Live June 2014 with
bed-level detail across the
hospital.
•QSight is a perpetual inventory system which
allows end-users to easily manage their
inventory
•More accurate management of high-value
inventory
•Provides easy reporting showing value of
inventory and value consigned vs. owned
•Tracks expiration dates and provides alerts of
near-expiration items and expired items
•Alerts users of recalled products held in
inventory by tracking lot and serial information, if
vendor provided
•Helps prevent stock-outs
•Facilitates easy and accurate patient charging
•Implementation began in 2010
•Currently 19 areas are using QSight for their
inventory control
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Locations In
Use:
GMC:
Cardiac Cath
Lab
EP Lab
Perfusion
Endoscopy
Cat Scan
IR
Neurointerv
Endovascular
GWV:
Cardiac Cath
Lab
EP Lab
Perfusion
Endoscopy
Endovascular
GCMC:
Cardiac Cath
Lab
IR
EP Lab
Healthcare Supply Chain Data Standards
Geisinger is a part of the Healthcare
Transformation Group (HTG) leading the adoption
of Healthcare Supply Chain Data Standards
Data Standards Include:
• GS1 Data Standards
– Global Location Number (GLN)-Where/Place
– Global Trade Item Number (GTIN)-What
– Global Data Synchronization Network (GDSN)
• Unique Device Identifier (UDI)-What
– Will start with class 3 devices
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FDA & New Rule
•What’s Known
• Medical devices are far behind drugs in terms of ability to
track product use.
• FDA will soon require manufacturers to label all devices
with a UDI (unique across manufacturers, products)
•What’s Unknown
• How health systems, providers will use the UDI in their EHR
and in daily operations, to improve patient care and
decision-making
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Drug Supply Chain Security Act
(DSCSA)
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TRANSFORMATION
FROM:
SUPPLY CHAIN
PHARMACY
TO:
CARE SUPPORT SERVICES
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Transformation to Care Support Services
“The creation of the Care Support Service Division is designed to
further Geisinger’s patient care mission and vision, as well as
support our ongoing commitment to innovative solutions for today’s
health care challenges. Under this umbrella, we will house our supply
chain and new consolidated pharmacy service lines to leverage
opportunities across the health system. With the creation of the
Enterprise Pharmacy, our patients will experience enhanced benefits
such as use of common drugs across the system and a cohesive
approach to their use across disciplines. For Supply Chain, we are
pushing the support of supply management closer to the front line of
care. And for Geisinger, we will be able to leverage economies of
scale that will have a direct impact on our purchasing power.”
- Glenn Steele, Jr., MD, Ph.D.
President & CEO
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Geisinger Health System
Enterprise Pharmacy
ED
Hospital
Health Plan
Ambulatory
•Med Reconciliation
•Care Paths
•Drug Benefit
Management
•Protocols & Care Paths
•Med Reconciliation
•Clinical/Medication
Therapy Management
Programs
•Clinical Programs
•Medication Stewardship
•Medication Stewardship
•Clinical Programs
•Medication Adherence
•Concierge Discharge
Program for Compliance
• Treat-to-Target HEDIS
metrics
• Specialty/Biologic
Oncologic
Management
•Chronic Disease
Management
•Capture Retail
Volume/Refills
Specialized
Outpatient Settings
•Infusion
•Specialty Pharmacy
•Rehabilitation and Long
Term Care Facilities
Support
•Home Care Support
Pharmacy Care Coordination & Enterprise EHR
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FOUR CAPABILITIES
• Agile Execution
– Flexible resource allocation
– Improving collaboration
– Formulating plans
• Adaptable Structure
– Products, processes and systems that are easily modified in response to
changing conditions
– Flexible response to demand shifts
– “Enterprise-wide” oversight
• Insight to Action
– Sensing, capturing and analyzing internal and external data yielding usable
business intelligence
– Improve the ability to buffer risk while leveraging new opportunities
• Flexible Innovation
– Smooth and rapid rebalance of operations to respond to shifting conditions
– Advantaging technology
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CONTRACTING IMPACT
•
•
•
•
Understanding of requirements of new “population management” structures
– No longer “owned, leased, managed” only
• Co-operative models
• Shared services
• Exchanges
Subpopulation targets
– Merged patient needs: elimination of class of trade boundaries
– Payer economic oversight/Provider quality delivery; Contracting partners?
– Risk stratification and control to decrease cost
– Outcomes-driven decisions
– Patient role in disease management
Data is key competitive advantage
– Data Standards in healthcare application a must
– Clinician collaboration
– New metrics
– Simplified contracting and execution
New relationships?
– Role of vendor representatives: sales v. service
– Value v. volume
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SUMMARY
TARGETS FOR IMPROVEMENT:
Increase Throughput
Decrease Variation
Enhance “Wall Thickness”
OPPORTUNITIES:
Provider/Payer relationships
Support Services and Care Giver collaboration
SUPPORTING IMPROVED OUTCOMES AND
DECREASES IN OVERALL COST
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CARE SUPPORT SERVICES
“Redefining Boundaries”
Healthcare Transformation [Peace] is a daily, weekly, a monthly process, gradually
changing opinions, slowly eroding old barriers, quietly building new structures.
~ John F. Kennedy
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