Program Managers Meeting

1
Vaccine Management Business Improvement
Project(VMBIP)

• Program Managers Meeting
• New Orleans, LA
• November 18, 2008

2
Todays Speakers

• Brad Prescott, VMBIP Team Lead
• Julie Orta, VMBIP Assistant Lead
• Jeanne Santoli, Acting Branch Chief, VSAB, and
  Deputy Division
  Director, ISD
• Karron Singleton, VACMAN Team Lead
• Tonya Martin, CCID Informatics Lead
• Janet Kelly, ISD VTrckS Lead

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Agenda

• Describe VMBIP and its workstreams Brad
• Overview of communications team Brad
• Recommendations from AIM vaccine distribution
  workgroup Brad
• Continuous Quality Improvement (CQI) Update Brad
• Economic Order Quantity (EOQ) Julie
• Centralized distribution update Jeanne
• Flu update Jeanne

• VACMAN update Karron
• VTrckS update Janet, Tonya
• VTrckS background and overview
• Governance and release strategy communications
• Project level update
• Grantee Advisory Committee update
• Pilot and Contact Center update Brad and Julie
• Next steps

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VMBIP Overview
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VMBIP Workstreams

• Communications
• Continuous quality improvement (CQI)
• Data systems and reporting
• Grantee/provider efficiencies
• Economic order quantity (EOQ)
• Centralized distribution
• VACMAN
• VTrckS
• VTrckS pilot
• Contact center
• Funds management and replenishment
• Data warehouse
• Stockpile

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VMBIP Communications

• In order to support the vast communications needs
  of VMBIP, a larger communications team has been
  established
• The communications team will focus on the
  following tasks
• Develop a communications strategy for VMBIP
• Create a marketing strategy to showcase the VMBIP
  milestones
• Coordinate the project-specific communication
  tasks to ensure consistency of message
• Establish a partnership with stakeholders such as
  AIM and grantees through initiatives such as the
  Grantee Advisory Committee (GAC) and the Provider
  Advisory Committee (PAC)
• Ensure stakeholders are kept abreast of changes
  in the program and how they will be impacted

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The AIM Vaccine Distribution Workgroups
recommendations

• Provision of real time, accurate inventory
  information (CQI)
• Replenishment and monitoring reports (RAM)
• Monthly allocation (VSAB)
• Shipment of vaccine as quickly as possible (CQI)
• Quality improvement for vaccine distribution and
  shipment monitoring (CQI)
• Timeliness of data receipt and vaccine shipments
  (CQI)
• VACMAN

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CQI update
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Data, Systems, and Reporting CQI Initiatives
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Grantee/Provider Efficiency CQI
The CQI is targeted to provide grantees,
providers, and field representatives tools and
methods that are designed to improve operational
performance as it pertains to vaccine orders.
Grantees
Providers
Field Representatives

• Grantees can be provided the tools and methods to
  improve internal efficiencies by understanding
  their labor requirements and communicating real
  performance

• Providers can benefit by implementing operational
  best practices to improve efficiencies and
  accountability

• Field Representatives will be better equipped to
  support the providers vaccine storage needs for
  their assigned providers and reduce wastage

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(No Transcript)
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EOQ Pilot Grantees
Benefits and Discussion

• Pilot grantees selected based on potential cost
  savings and grantees interest in EOQ
• Monthly reports of the grantees ordering
  behavior and comparisons to ideal EOQ tiers
• Development and implementation of tools,
  educational materials, change management
  strategies
• VTrckS will support EOQ implementation
• Current ordering behavior primarily occurs during
  the beginning of the month, leading to large
  peaks initially
• Smoother ordering throughout the month brings
  predictability to the workloads at the DCs
• EOQ tiers reduce the number of orders placed by
  each provider and entered by grantees

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Centralized Distribution

• Transition of Centralized Distribution Support
• Transmission of Orders from CDC
• Flu vaccine ordering/distribution

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Transmission of Orders from CDC

• Once received at CDC, provider orders are
  transmitted to McKesson each morning in a single
  batch
• If the transmission is interrupted for any
  reason, fewer orders (or no orders) may be
  transmitted to McKesson, with a concomitant
  increase in transmission the following day
• This situation is generally infrequent, but we
  are aware of two examples that occurred within a
  5 week period this fall Sept 8 and October 13

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Transmission of Orders from CDC

• The first interruption due to temporary SDN
  outage, the second due a federal holiday when
  automatic transmission was inadvertently not
  programmed to occur.
• Transmission interruptions have significant
  impacts on McKesson
• We have put in place some strategies to
• Prevent transmission problems that can be
  prevented (holiday transmission)
• Implement real time monitoring of order line
  transmission to identify problems as soon as they
  occur.
• Once a transmission problem is identified, CDC
  will work with McKesson to determine an estimate
  of impact and communicate the information with
  grantees immediately.

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Non Flu Work Queue at McKesson
9/12 - 9/26 Orders Held For Hurricanes
10/13 Columbus Day
9/9 CDC SDN Issue
91.3
86.4
82.3
69.1
73.3
69.7
52.2
55.0
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New Allocation Functionality in NIPVAC

• Initiated this year for flu vaccine, but a
  potential model for other allocated vaccines
• Tracks orders versus allocation and holds orders
  at CDC if they are over the allocation
• Limited to doses available on CDC contract
  (though it includes doses purchased on CDC
  contracts as well as other mechanism)
• Provides daily balance information to grantees
  via an auto-generated email

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Daily Flu Allocation Balance Report
Grantee Vaccine NDC
Season Avail Approved Held Bal
Example
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Challenges (so far)

• Initial inability to make manual changessolution
  developed
• Confusion over grantee receipts for flu vaccine
  purchased with state funds on the CDC contract
• Allocations for non-contract doses
• Novartis swap out
• Returning cancelled orders to the
  allocationsolution developed
• Flu swaps

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Assessing the delivery of flu vaccines

• Goal for flu is delivery within 3 business days
• The day the order is received at McKesson is the
  first business day
• Current weekly metrics do not take provider
  office hours into account
• Shorter processing time for flu vaccine makes
  provider office hour restrictions critical to
  assess performance
• VACMAN data on provider office hours is difficult
  to manipulate (VTrckS will address this)
• CDC working to finalize flu metrics to take
  provider office hour restrictions into account

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2008 Influenza Season Metrics

• 80 of all influenza received has shipped (as of
  11/14)
• 10.8 MM Doses Shipped
• 13.5 MM Doses Received
• Doses Returned/Wasted (as of 11/14)
• 32K Doses Wasted (.29)
• Undeliverable/Customer Not Available
• Incorrect Address
• Order Error
• Temp Monitor

9/25/2009
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VACMAN UPDATEOrders Processed 2/5/07
11/14/08

• VACMAN/NIPVAC STATS
• ORDER LINES PROCESSED 1,992,767
• ORDER LINE RECEIPTS PROCESSED 2,106,009
• ORDER LINES CANCELLED 9,323
• SHIPMENTS CANCELLED FROM MCKESSON 1,292
• REPLENISHMENT ORDERS 5,625

Data Source NIPVAC
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VACMAN UPDATERelease Status
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VACMAN UPDATERelease Status

• CORRECTIVE ACTIONS
• CONTROL SOURCE CODE
• DEVELOP COMPREHENSIVE TEST PLAN
• -- FULL REGRESSION TESTING
• INDEPENDENT TESTER FOR QUALITY ASSURANCE

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VACMAN UPDATEGrantee Questions/Comments
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High-level architecture of the VMBIP environment,
including CDC and McKesson IT systems
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VACMAN UPDATEGrantee Questions/Comments
ACTUAL ORDER TO RECEIPT TIMELINE
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VACMAN CONTINUOUS QUALITY IMPROVEMENT

• IMPLEMENTED IN 2008
• ORDER ID TRACKING
• REJECTED ORDERS EMAIL TO VSAB
• RECEIPTS OUTSTANDING gt 21 DAYS
• FUNDING THRESHOLD REPORT TO RAM TEAM
• -- QUARTERLY PROJECTIONS VICE ANNUAL
  PROJECTIONS
• MULTIPLE RECEIPT SCREEN IN VACMAN
• ALLOCATION MANAGEMENT
• WEBINAR TRAINING
• EARLY 2009
• SEND ORDERS TO MCKESSON USING EDI

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VACMAN SUMMARY

• VACMAN/NIPVAC STATISTICS
• VACMAN UPDATE
• CONTINUOUS QUALITY IMPROVEMENT

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This document

• This document can be found on the CDC website at
• http//www.cdc.gov/vaccines/programs/vmbip/downlo
  ads/newsletters/downloads/newsletters/vmbip-pmm-08
  -final.ppt