HCA Pharmacy Centralized Distribution · PDF file6 6 Project Scope • The scope of...
Transcript of HCA Pharmacy Centralized Distribution · PDF file6 6 Project Scope • The scope of...
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© 2011 Parallon Business Solutions, LLC.
HCAPharmacyCentralizedDistribution
JanetZarndt,Pharm.D.DivisionDirectorofPharmacy
HCAMountainDivision
PharmacyDistribution
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Optimizing the Present Preparing for
the Future
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Pressures Mandates
•PayForPerformanceImperative
•PopulationHealthManagement
•LaborCosts↑
•PharmacyCosts↑
•Reimbursements↓
•ControlExpenseGrowth
•IntegrateNewPayment&CareDeliveryModels
•ImproveOutcomes
•AccelerateValueAcrossCareContinuum
•TransformPharmacytoStrategicAsset
ImplementingSolutionsthataddressalldimensionsof
pharmaceuticalandoperatingexpensewhilepreservingtheclinicalfoundationandenhancingoutcomes
HighPerformingPharmacy
HealthcareReform….AChallengingEnvironment
IncreasedOperatingMarginPressure
InnovatetobeLow-CostProvider
HealthcareChallenges
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PharmacyIndustryChallenges
CostIncreasesDrugShortages
• Over260criticalshortages
• Non-contractpurchasesorhighercostentities>$10M
• Notlikelytoresolveinnearterm
• Brandeditems/contractincreasesresultedinover$70Mimpactin2014,$80Min2015
• Solegenerics,companymergers
• Unapproveddruglegislation
• Exparel-Surgery
• IVTylenol-Surgery
• OutPtInfusion
• ExpansionofInfusion Services,Transplant,Stroke,CV-high costdrugtherapies
HighCostDrugs
• Newcompoundingregulationsfederally
• StateregulationsonIVAdmixtureServices
• FDARegulationswilldetermineoutsourcedvendors
Compounding
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OptimizationofPharmacyResourcestoDriveaHighPerformancePharmacy
HighQuality,Cost
EffectiveCare
LeadershipDevelopment
ClinicalPharmacyandFormulary
OperationsandAutomation
Standardization
TechnologyCPOE/EHRVigilanz
CentralizedOrderEntry
CentralizedDistribution
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ProjectScope
• The scope of implementing a company wide pharmacy distribution program starts with purchasing of drugs to delivering of drugs to the facility. The process includes:
• Centralized drug purchasing and distribution• Centralized drug packaging and barcoding if required• Reduce number of drug SKUs through a centralized formulary
management• Implement a facility pharmacy inventory management system• Standardization of pharmacy operations across the enterprise• Implement a SMART/WMS interface with the automated dispensing
cabinets• Enhanced reporting capabilities
• The following are out of scope for this project:• Controlled substances• Centralized medication cart fill• IV compounded medications• Patient specific filling
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DistributionTimeline2011• Nashville2014• North Texas • Jacksonville 2015• Richmond • Denver • Kansas City • Houston • Tampa 2016• Salt Lake City• San Antonio• Atlanta• Miami• Austin
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MajorBenefitsofConsolidatedPharmacy
Effectiveness Efficiency
Expe
nseRe
duction
• Reduce PharmacyExpense/APD
• ReduceSKUs
• ReduceOn-HandInventory
• ImproveInventoryTurns
• ReduceDrugStockOuts
• ReduceExpiredDrugs
• ReduceFacilityTimeonSupplyChainFunctions oldertext
• InventoryManagement
• Automation ofDrug
Replenishment
• CentralizedDrugPurchasing
• CentralizeCriticalDrugStockpiles
• DrugFormularyManagement
• PharmacyTechnology
Stan
dard
Ope
ratin
gMod
el
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PharmacySupplyChainFunctions
AccountPayables
Procurement Standardization
• Requisitioning• ContractCompliance• Monitoring
• Direct• Non-Stock Items
• Optimizingdiscountsandrebates
• Analyzepurchasinganddistribution
• Ensureappropriatepricing
• Receiving• Picking• Optimizing
distribution• Efficientuseof
space
Logistics
• Inventorymanagement
• Wastereduction
• Formularystandardization
• Utilizationmanagement
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DistributionTimelineforMountainCSC
ProjectKickoffwithO’s
CustomizeProjectPlans
ImplementFormularyandSKU
ImplementOptiFlexinFacility
PharmacyWorkflow Design
OpenCSCPharmacy
BeginDistribution to1st site
ImplementRemainderofSites
MayJuneJulyAugSeptOctNovDecJan.Feb. Mar
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MetricstoDetermineFacilityDeployment
CartlessDistribution
Model
CSCFormularyImplemented/
SKUReduction
PyxisOptimizationComplete
PharmacyWorkflowOptimized
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HowDoWeDetermineSuccess?
• ReductionofPharmacydrugexpense/APD
• Reductionindrugproductsstockedateachfacility
• Standardizationofinventorymanagement
• Pharmacistandpharmacytechniciansperformingotherclinicalfunctions
Metrics Outcome
PharmacyExpense/APD
MeetestablishedPharmacyExpense/APDtarget
FacilityDrugInventory Turns
12inventoryturns/year
ContractLostOpportunity
Reductionin lostopportunityspendoverprioryear
Drug Waste Reduce amountofexpireddrugs
SKU Reduction ReducenumberofuniqueNDCscarriedineachfacility
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LessonsLearned• People
o RedeploymentofPharmacistsfromtaskorientedprocessestopatientcareo RedefinedroleofPharmacyTechniciantofreeuptimeforPharmacisto Defined resourcesnecessarytosustaininventoryoptimizationatthefacilityo Divisionandfacilityleadershipsupport forformularyworkandoperational
changes• Process
o Optimizedformularystandardizationexecutionthrough visibilityatservicecentero RealizedSKUreductionfrom6800lineitemspurchased to1400itemso Standardized facilitypharmacyoperationsprocesseso Heightenedawarenessofinventorymanagementopportunitieso Standardized pharmacydistributionmodel
• Technologyo Difficulty tofindenterprisetechnology tosupport afullyconsolidatedmodelo Reducedautomationandautomationlaborexpensethrough eliminationof
contracts
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CurrentStateMountain– PharmacyInventory
• $ 5 million in drug inventory in MTN
• $4.5 million @ facilities
• $ 430,337 in expired meds last 12 months
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~ $ 3.5 million stored in Pyxis cabinetsRepresenting approx 19% of inventory
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Inventory Turns for Mountain FacilitiesFacility InventoryTurns
Alaska 7.84BrighamCity 4.72CacheValley 4EIRMC 12.12Lakeview 7.15LonePeak 3.94MountainView 8.97Ogden 6.56St.Mark’s 10.82Timpanogos 6.84WestValley 7.52
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CVH BCCH EIRMC LVH LPH MVH ORMC SMH TRH
PyxisMedStations
PyxisNursingLocationsforMountainFacilities
203 cabinet locations
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Facility ADUs are polled by Center to generate replenishment order
• Hospital Automated Dispensing Cabinet (ADU)• Hospital Pharmacy Department scans product
•Receives requisition•Product picked in low units of measure•Product placed in tote
Truck/courier deliverstotes to hospital
Pharmacy receives product and inventory is replenished
Mountain Division Supply Chain
PharmacyReplenishmentProcess
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OverarchingGoal- ImprovementinPatientCare
ReduceNon-ClinicalActivities
FocusonClinicalActivities
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© 2011 Parallon Business Solutions, LLC.
Questions
PharmacyDistribution