Post on 26-Mar-2015
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Program Managers’ Meeting
Atlanta, GA
January 21, 2010
Vaccine Management Business Improvement Project
(VMBIP)
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VMBIP Overview Centralized Distribution Continuous Quality Improvement (CQI) Vaccine Tracking System (VTrckS)
– VTrckS Update– Rollout Strategy and Training– VTrckS Provider Order Pilot (VPOP)– Grantee Advisory Committee (GAC)
Table of Contents
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Vaccine Management Business Improvement Project (VMBIP)
A national project in scope that addresses all areas related to public-sector vaccine management
Supported by the original business plan approved by HHS and Office of Management and Budget (OMB) in 2004
Focus on developing an efficient and reliable infrastructure for decades to come
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VMBIP addresses all critical aspects of public sector vaccine management
Vaccine Distribution
Vaccine Tracking System (VTrckS)
Stockpile Management
Internal Efficiencies
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VMBIP is comprised of 11 workstreams (teams)
Project Management Office
Strategic Marketing
Organizational Change Management
Centralized Distribution
VTrckS
Data Warehouse
VTrckS Provider Order Pilot (VPOP)
VMBIP Contact Center
Continuous Quality Improvement Initiatives
Inventory and Funds Management
Stockpile Management
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VMBIP benefits to date
Improved shortage management capabilities
Increased visibility into national public-sector supply and provider vaccine ordering practices
Eliminated multiple DA-Vaccine funding rounds via grant awards through funds management efficiencies
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VMBIP benefits to date
Able to project national vaccine demand based on actual data
Strengthened vaccine handling and storage practices (fewer touches and fully insured while in storage)
CDC access to vaccine stockpiles stored at McKesson
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The H1N1 response had an impact on select VMBIP activities leading to…
Assessment of federal and state subject matter expert availability
Comprehensive review of the 11 workstreams in terms of cost, schedule, and scope
Review of all vendors’ participation Decision to delay VTrckS deployment from
original date of December 2009
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Today’s presentation will focus on the following VMBIP activities
Centralized Distribution Continuous Quality Improvement (CQI)
– Economic Order Quantity (EOQ)
– Grantee and Provider Efficiency (GPE)
Vaccine Tracking System (VTrckS)– VTrckS Update
– Rollout Strategy and Training
– VTrckS Provider Order Pilot (VPOP)
– Grantee Advisory Committee (GAC)9
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VMBIP Overview Centralized Distribution Continuous Quality Improvement (CQI) Vaccine Tracking System (VTrckS)
– VTrckS Update– Rollout Strategy and Training– VTrckS Provider Order Pilot (VPOP)– Grantee Advisory Committee (GAC)
Table of Contents
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Centralized Distribution: Topics
Overview
Seasonal Flu Distribution
Customer Service
Lessons learned from liability reviews
Reminder about needle returns
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Centralized Distribution: Overview
Depots
• Memphis (new facility replaced original facility 9/2009)
• Sacramento
2009 Statistics (as of 12/25/2009)
– Doses shipped, year to date: 79.5 million
– Orders shipped, year to date: 433k
– Average doses/shipment: 195 doses
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Seasonal Flu Distribution, I Seasonal flu supply at centralized distribution depots
– Doses ordered on CDC contracts: 15.8M doses (first pre-book); ~315K doses (second pre-book)
– Doses ordered by states via other mechanisms: ~1.9 M doses– Doses to be released from Flu Stockpiles: ~450K – Total flu doses ordered to depots: ~18.5 M doses
Flu Vaccine Doses Received* at Depots by Month
5 9.713.9 15.1
18.5
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20
AUG SEPT OCT NOV DEC
Mill
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*Receiving through end of month.
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Seasonal Flu Distribution, II
Changes in Seasonal Flu Approach for 09-10 Season
– Timing of FluMist delivery to the depots• Expired vaccine in 08-09• Survey of Grantees July 2009
– Provided anticipated monthly schedule of depot deliveries by manufacturer as part of flu guidance document
– Updated Format for Grantee Allocation Balance Report• Based on feedback re: H1N1 distribution• Excel spreadsheet format provided beginning 11/03/09
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Seasonal Flu Distribution, III
Order Placed Order Received at Distributor Order Shipped Out
Friday Monday Wednesday
Monday Tuesday Thursday
Tuesday Wednesday Monday
Wednesday Thursday Tuesday
Thursday Friday Wednesday
Shipping Schedule
09-10 Flu Season Metrics
>=95% 93-94.9% <93% Daily order lines >625K doses
Green Yellow Red White
8/28 9/4 9/11 9/18 9/25 10/2 10/9 10/16 10/23100% 80% 84% 73% 44% 78% 96% 100% 99%10/30 11/6 11/13 11/20 11/27 12/4 12/11 12/18 12/25
99% 99% 100% 99% 99% 99% 99% 96% 100%
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Customer Service
February contract modification defined metrics for customer service
Customer service tickets fully resolved within 24 business hours
• Priority #1—8 business hours• Priority #2—16 business hours• Priority #3—24 business hours
Help Desk (HD) Resolvable customer service tickets fully resolved within one hour of inbound contact (i.e., call or email)
Customer service tickets re-opened due to lack of satisfactory resolution within previous 3 business days
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Customer Service
Cold Temp Monitor IssueEmergency OrderHot Temp Monitor IssueMissing ProductProduct DamagedOrder CancellationProduct Recovery
Back Order Report Inquiry
Cold chain Packout ProblemAllocation StatusDiluent RequestPacking Slip ErrorSplit ShipmentBox Returns/FET returnsCarrier IssuesRe-Route to DCReturn Label RequestShipping Log Error
Priority 1
Priority 2
Priority 3
Call Topic Priority Group
Order HoldOrder StatusBox ReturnsFET ReturnsReturn Label Request
HD Resolvable Customer
Service Tickets
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Customer Service
Top Five Call Types--May-September 2009
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MAY JUN JUL AUG SEP
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Order Cancellation
Order Status
Return Label Request
FET Return
Box Return
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Customer ServicePerformance Metrics
Excellent Good Fair UnsatPriority 1 >= 90% >= 80% >= 70% < 70%Priority 2 >= 90% >= 80% >= 70% < 70%Priority 3 >= 90% < 80% >= 70% < 70%HDR >= 95% >= 85% >= 85% < 85%Re-opened tickets <= 3% <= 4% <= 5% > 5%
*December metrics are preliminary.
MetricMetric Cutoff May June July Aug Sept Oct Nov Dec*
Priority 1 70% 89% 82% 76% 69% 67% 75% 70% 75%Priority 2 70% 98% 94% 92% 90% 76% 84% 89% 91%Priority 3 70% 99% 92% 93% 90% 77% 88% 95% 89%HD Resolvable 85% 83% 73% 78% 90% 81% 89% 89% 91%Re-opened tickets 5% 0% 0.12% 0.09% 0.07% 0.02% 0.13% 0.13% 0.05%
Month
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Customer Service: Responding to Re-Route Messages
McKesson carries out a rescue process by monitoring outbound FedEx shipments to retrieve shipments out for delivery > 24 hours
When shipments are retrieved, grantees receive a call or email from Customer Service to determine if order should be reshipped, correct address/office hours information, etc.
Grantees asked to respond within 72 hours; if no response within that time, orders will be cancelled and vaccine placed into inventory and the grantee will be notified of order cancellation via email
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Lessons Learned from Liability Reviews
Preventable vaccine losses include shipments in which . . .
Providers contact Fed Ex directly to ask that shipments be delivered at a later date or time
Providers refuse shipments that they believe have been cancelled, don’t remember they ordered, appear damaged
Providers are not available during stated office hours
Vaccine is delivered outside of stated office hours
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Unsafe Vaccine Returns Continue to Occur
Thank you for continuing to follow up with and educate your providers on this important issue.
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For more information, please contact…
Cameron Noblit (cnoblit@cdc.gov) – Team Lead, Vaccine Supply and Distribution Team
Sally Somerfeldt (ssomerfeldt@cdc.gov)– Project Officer, Distribution Contract
Helen Kuykendall (hkuykendall@cdc.gov)– Project Officer, Distribution Contract
Lisa Galloway (lgalloway@cdc.gov) – Project Officer, Distribution Contract
Jeanne Santoli (jsantoli@cdc.gov) – Acting Chief, Vaccine Supply and Assurance Branch
…and please copy your POB project officer
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VMBIP Overview Centralized Distribution Continuous Quality Improvement (CQI)
– Economic Order Quantity (EOQ)– Grantee and Provider Efficiency (GPE)
Vaccine Tracking System (VTrckS)– VTrckS Update– Rollout Strategy and Training– VTrckS Provider Order Pilot (VPOP)– Grantee Advisory Committee (GAC)
Table of Contents
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Economic Order Quantity (EOQ): Background
Inefficiency in how providers currently place vaccine orders – A lot of small orders– Multiple orders from same providers in short
period of time– Spike in orders at beginning of every month
We can work together to improve efficiency and minimize costs
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Economic Order Quantity (EOQ): What is it?
Creates efficiencies in provider orders 1. How often to order (monthly, bimonthly,
quarterly, or as-needed)2. When to order (two-week order windows)
We encourage you to do it
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EOQ: How often to order
Exceptions– Grantees in which McKesson does not ship directly to providers– Direct-ship vaccines – Influenza vaccines (seasonal and H1N1)– Vaccines on allocation <6 months– Providers that you assign a different frequency
Order Frequency Annual Vaccine Doses
Monthly 6,000 or more
Bimonthly 800 – 5,999
Quarterly 200 – 799
As Needed 199 or less
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EOQ: When to orderD
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Memphis Distribution Center Sacramento Distribution Center
Current order pattern: Spikes at beginning of month
(inefficient)
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EOQ: When to order (two-week order windows)
Do
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Memphis Distribution Center Sacramento Distribution Center
Illustrative
Illustrative
Desired: smooth order flow throughout the month
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EOQ: What’s in it for me?
Overall fewer orders to process
Improved ability to order right quantity for your providers
Spread workflow throughout the month
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EOQ: Common themes from pilot grantees
Many providers do not know how much vaccine to order
Storage capacity concerns Grantees get “slammed” with orders at
beginning of the month Providers are open to ordering later in the
month
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EOQ Tools: Provider Ordering Calendar
Two-week order windows
Illustrative
Illustrative
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Your inputs:– On-hand inventory– Refrigerator size
Preloaded inputs:– Order frequency – Five-week safety
stock– Past distribution data– Seasonality
EOQ Ordering Tool
Recommendedorder quantity
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Grantee and Provider Efficiency (GPE): What is it?
Continuous quality improvement (CQI) experts– Observe your vaccine order/review processes
– Recommend improvements
– Develop tools
– Provide training
Incorporates EOQ
Examples of improvements– Reduced order processing time by 41 percent
– Increased order accuracy by 27 percent 34
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GPE: What’s in it for me?
All the benefits of EOQ
Plus the benefits of other industry best practices on your entire vaccine order/review system…
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GPE ToolboxesProvider Toolbox
– Checklists for receiving and storing vaccine– Visual aids– Refrigerator size needed– How much vaccine to order
Grantee Toolboxes– Manage vaccine allocations– Prioritize provider site visits– Standardize daily routine tasks– Plan staffing needs– Track program performance metrics
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New Mexico
Texas
Oklahoma Arkansas
Alabama
Kentucky
Wisconsin New York
Maine
Philadelphia
Hawaii
Guam Marshall Islands
Republic of Palau
MicronesiaAmerican Samoa
N. Mariana Island
San Antonio
Chicago
New York City
Houston
EOQ+GPEEOQ onlyGPE only
District of Columbia
EOQ and GPE: Participating Grantees
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EOQ and GPE: Where are we going?
Convene recurring group calls Conduct site visits Develop/refine communications templates
and data tools Utilize standard template to track
progress
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For more information, please contact…
Julie OrtaVMBIP Assistant Leadjulie.orta@cdc.hhs.gov
…and please copy your POB project officer39
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VMBIP Overview Centralized Distribution Continuous Quality Improvement (CQI) Vaccine Tracking System (VTrckS)
– VTrckS Update– Rollout Strategy and Training– VTrckS Provider Order Pilot (VPOP)– Grantee Advisory Committee (GAC)
Table of Contents
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VTrckS: What is it?
Vaccine Tracking System (VTrckS)
– Online information technology system
– Integrates the entire vaccine supply chain of publicly funded vaccine
• Purchase
• Ordering
• Inventory
• Distribution
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VTrckS: Benefits
Benefit to providers: ability to directly enter vaccine requests (orders)
Benefit to grantees: ability to manage vaccine orders by exception; replacement of CDC legacy systems (VACMAN, NIPVAC)
Benefit to CDC: centralization of vaccine management (ordering, distribution, inventory, invoices); replacement of legacy systems; adaptable system
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Needs and Forecasts– Develops vaccine needs assessment and spend plan– Develops annual need forecasts for providers
Manage Contract Balances– Provides thresholds and notifications that support the
processing of direct-ship orders and grantee-funded replenishment orders
Manage Vaccine Inventory– Provides information on order status, shipment status,
grantee-specific inventory, and provider inventory
VTrckS: Grantee Features
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Provider Fulfillment– Allows the providers to order vaccine online– Allows grantees to process provider orders– Provides order history– Allows the management of provider accounts– Provides broadcast capabilities via fax or e-mail
Grantee Monitoring– Updates and maintains available vaccine list– Compares vaccine usage against spend plans
VTrckS: Grantee Features
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VTrckS: Implementation when?
Depends on analysis in progress
Deployment tentatively planned summer 2010
Release 1 functionality
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VMBIP Overview Centralized Distribution Continuous Quality Improvement (CQI) Vaccine Tracking System (VTrckS)
– VTrckS Update– Rollout Strategy and Training– VTrckS Provider Order Pilot (VPOP)– Grantee Advisory Committee (GAC)
Table of Contents
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VTrckS Release 1: Proposed Rollout Strategy
Go-Live Go-Live Go-Live
CDC back office function users
VPOP Grantees
Volunteer Grantees and Provider Transition
Six-month Pilot Period½ of the
remaining grantees
Remaining Grantees
Continued Provider TransitionWave 1
Wave 2
Eval. and Feedback
Period
Continued Provider Transition
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VTrckS Release 1: Proposed Strategy
Lessons learned from centralized distribution and VTrckS Provider Order Pilot (VPOP) will be factored in
Six-month pilot of full VTrckS
One-month evaluation and feedback period at end of pilot
Provider rollout options will be available
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VTrckS Training: Proposed Strategy
Develop plans for VTrckS training, pending new rollout schedule
Incorporate feedback and lessons learned from VPOP training efforts
Conduct train-the-trainer with grantees
Explore grantee pre go-live site visits similar to centralized distribution
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VPOP: Background
Key terms:
– VTrckS Provider Order Pilot (VPOP): a formal evaluation of the online provider ordering functionality proposed for VTrckS
– Provider Advisory Committee (PAC): provider based groups designed to provide CDC with direct feedback related to VTrckS
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VPOP: Background
Why are we doing VPOP?
– Conduct a test run of implementing the online ordering processes
– Engage the provider community
– Capture feedback and lessons learned from grantees and providers to apply to full VTrckS
– Reduce grantee burden of handling paper forms and increase order accuracy
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Topic VPOPVTrckS (various
releases)
ParticipantsFour grantees
and select providers
All grantees and providers, at the
grantees’ discretion
ExIS/IIS Integration No Yes
VACMAN Use Yes No
Order StatusLimited to order
confirmationOrder confirmation to shipment information
Grantee Access No Yes
Provider online ordering/submission of
accountability dataYes Yes
VPOP: How does VPOP differ from VTrckS?
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VPOP: Overall project success criteria
Go-live with a working system that is representative of basic VTrckS processes
– May 18, 2009: phased rollout of four pilot grantees (MA, CA, CHI, CO)
VPOP providers successfully order vaccine online
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VPOP: Ordering activity
Grantee
Go-live Date
Active provider sites/users Orders
Massachusetts May 20 58/77 106
California June 1 16/34 76
Chicago June 15 105/197 272
Colorado July 6 37/41 185
Total 216/349 645
May 18, 2009 - Dec 31, 2009
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VPOP: Overall project success criteriaGrantee level of effort to process provider
vaccine orders is reduced– Manual data entry of orders is not required, however,
some grantees developed alternate methods to support their procedures
An evaluation plan to incorporate feedback was developed and implemented– Six month formal evaluation period
VPOP feedback was captured and considered for full VTrckS– Five changes are in production, two of which were
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VPOP: Critical changes based on user feedback
Make the accountability screen easier to read (lock the column headings during scrolling)
Create a warning when the system is about to time out
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VPOP: Evaluation results
Highlights from provider evaluations
– In October, 76% agreed that the system was easy to use, up from 45% in June
– In October, 71% agreed that VTrckS was a suitable replacement for existing vaccine ordering methods, up from 65% in June
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VPOP: Evaluation results
Highlights from provider evaluations (continued)
– 98% agreed that the Help Desk staff provided satisfactory customer service and were professional
– 52% agreed that “the process to obtain access to the VTrckS was easy to complete” and 28% disagreed with the statement
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VPOP: Acting on the evaluation findings
VTrckS Identity Proofing CQI
– Initiated due to a number of concerns raised by grantees and providers
– Document necessity for identity proofing process
– Expand definition of who can proof a user’s identity
– Create materials to educate and guide end users through the process
– Improve the grantee’s ability to monitor the status of providers in the identity proofing process
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VPOP: Where are we going?
Providers using VPOP will continue to use VPOP until full VTrckS is ready
Plans are underway to increase the number of providers using VPOP (VPOP grantees only)
Ad hoc evaluation will continue as needed Grantee and PAC calls will continue as needed Lessons learned and approved change
requests will be reviewed for possible incorporation into the implementation plans and functionality of future releases
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VMBIP Overview Centralized Distribution Continuous Quality Improvement (CQI) Vaccine Tracking System (VTrckS)
– VTrckS Update– Rollout Strategy and Training– VTrckS Provider Order Pilot (VPOP)– Grantee Advisory Committee (GAC)
Table of Contents
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VTrckS GAC: Background
GAC first convened in July 2008
Purpose and Activities– To ensure that grantee immunization program
needs are well represented throughout the development of VTrckS
• By reviewing plans
• By developing recommendations
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VTrckS GAC: Background
Membership– Co-chairs: Jan Hicks-Thomson (WA) and Gary
Rinaldi (NY)
– 21 members
• 13 grantees
• Leadership from the Association of Immunization Managers (AIM) and the American Immunization Registry Association (AIRA)
• CDC
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Specialized workgroups began to meet in early 2009
The purpose of the workgroups (except ExIS and Contact Center) was to review development work and provide feedback
Most workgroups (except ExIS and Contact Center) met three to five times by conference call or webinar between June and August 2009
Workgroup recommendations and feedback were approved by GAC before going formally to CDC
VTrckS GAC: Workgroups
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VTrckS GAC: Workgroups
Grantee Advisory Committee
External Information System (ExIS)
Provider & Grantee Ordering
Reports
Data Conversion & Roll-Out
Support Documentation
Contact Center Planning
Formally ended
89 participants from 28 different
grantees
Paused
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VTrckS GAC: Workgroups
Grantee Advisory Committee
External Information System (ExIS)
Provider & Grantee Ordering
Reports
Data Conversion & Roll-Out
Change Management (training, education, etc)
Support Documentation
Testing
Users Group & Evaluation
Contact Center Planning
Formally ended
Awaiting start
Paused
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VTrckS GAC: Where are we now?
The GAC continues to meet monthly to maintain VTrckS communication between grantees and CDC
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VTrckS GAC: Where are we now?
Some of the most important recommendations:
– Development of a VTrckS-ExIS interface document
– Recommendation of a pilot period
– Recommendations on how the Contact Center could respond to various types of vaccine order-related questions and issues
– Recommendation for customized doses administered forms and provider profiles
– Recommendation to not require NDCs in inventory
– Recommendation for temperature log input68
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VTrckS GAC: Thank you for being involved!
More than 100 recommendations, both programmatic and technical, have been made and heard
Your input and recommendations will make VTrckS a better product
Thank you for your participation. Please watch for more opportunities to become involved
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For more information, please contact… Kyle Wickes
VTrckS Leadkyle.wickes@cdc.hhs.gov
Joe McDowellIT Project Managerjoe.mcdowell@cdc.hhs.gov
Brad PrescottVMBIP Leadbrad.prescott@cdc.hhs.gov
Nathan CrawfordVTrckS Grantee Advisory Committee Lead ncrawford2@cdc.gov
…and please copy your POB project officer 70
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Questions?
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