Vaccine Management Business Improvement Project (VMBIP)

1. Vaccine Management Business Improvement Project(VMBIP) Program Managers Meeting New Orleans, LA November 18, 2008

2. Today’s 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

3. 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

4. VMBIP Overview

5. 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

6. 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

7. The AIM Vaccine Distribution Workgroup’s recommendations • Provision of real time, accurate inventory information (CQI) • Replenishment and monitoring reports (RA&M) • 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

8. CQI update

9. Data, Systems, and Reporting CQI Initiatives

10. 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 Field Representatives Providers • Grantees can be provided the tools and methods to improve internal efficiencies by understanding their labor requirements and communicating real performance • Field Representatives will be better equipped to support the providers’ vaccine storage needs for their assigned providers and reduce wastage • Providers can benefit by implementing operational best practices to improve efficiencies and accountability

12. Pilot EOQ Grantees NYC, Florida, Pennsylvania, and Oregon Oregon Oregon Oregon Oregon Pennsylvania Pennsylvania Pennsylvania Pennsylvania NYC NYC NYC NYC Florida Florida Florida Florida 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

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

14. 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

15. 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.

16. 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%

17. 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

18. ALASKA FLU 19515-0885-07 0 0 0 0 0 ALASKA FLU 49281-0008-10 0 0 0 0 0 ALASKA FLU 49281-0008-25 9700 9700 9700 0 0 ALASKA FLU 49281-0008-50 0 0 0 0 0 ALASKA FLU 49281-0382-15 67750 67750 67750 0 0 ALASKA FLU 58160-0875-46 0 0 0 0 0 ALASKA FLU 66019-0106-01 10000 10000 10000 0 0 ALASKA FLU 66521-0111-01 0 0 0 0 0 ALASKA FLU 66521-0111-10 0 0 0 0 0 Daily Flu Allocation Balance Report Grantee Vaccine NDC Season Avail Approved Held Bal Example

19. Challenges (so far) • Initial inability to make manual changes—solution 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 allocation—solution developed • Flu swaps

20. 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

21. 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 12/20/2019 21

22. 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

23. VACMAN UPDATERelease Status

24. VACMAN UPDATERelease Status • CORRECTIVE ACTIONS • CONTROL SOURCE CODE • DEVELOP COMPREHENSIVE TEST PLAN • -- FULL REGRESSION TESTING • INDEPENDENT TESTER FOR QUALITY ASSURANCE

25. VACMAN UPDATEGrantee Questions/Comments

26. High-level architecture of the VMBIP environment, including CDC and McKesson IT systems

27. VACMAN UPDATEGrantee Questions/Comments OPTIMUM TIMELINE FROM ORDER TO RECEIPT (SHIPPING) INFORMATION

28. VACMAN UPDATEGrantee Questions/Comments ACTUAL ORDER TO RECEIPT TIMELINE

29. VACMAN CONTINUOUS QUALITY IMPROVEMENT • IMPLEMENTED IN 2008 • ORDER ID TRACKING • REJECTED ORDERS – EMAIL TO VSAB • RECEIPTS OUTSTANDING > 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

30. VACMAN SUMMARY • VACMAN/NIPVAC STATISTICS • VACMAN UPDATE • CONTINUOUS QUALITY IMPROVEMENT