Vaccine Management Business Improvement Project (VMBIP)

1. Program Managers’ Meeting Atlanta, GA January 21, 2010 Vaccine Management Business Improvement Project (VMBIP)

2. Table of Contents • 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)

3. 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

4. VMBIP addresses all critical aspects of public sector vaccine management • Vaccine Distribution • Vaccine Tracking System (VTrckS) • Stockpile Management • Internal Efficiencies

5. 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 VMBIP is comprised of 11 workstreams (teams)

6. 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

7. 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

8. 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

9. 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)

10. Table of Contents • 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)

11. Centralized Distribution: Topics Overview Seasonal Flu Distribution Customer Service Lessons learned from liability reviews Reminder about needle returns

12. 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

13. 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 *Receiving through end of month.

14. 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

15. Seasonal Flu Distribution, III Shipping Schedule 09-10 Flu Season Metrics Green Yellow Red White

16. 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

17. Customer Service Call Topic Priority Group HD Resolvable Customer Service Tickets

18. Customer Service

19. Customer Service Performance Metrics *December metrics are preliminary.

20. 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

21. 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

22. Unsafe Vaccine Returns Continue to Occur Thank you for continuing to follow up with and educate your providers on this important issue.

23. 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

24. Table of Contents • 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)

25. 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

26. Economic Order Quantity (EOQ): What is it? Creates efficiencies in provider orders How often to order (monthly, bimonthly, quarterly, or as-needed) When to order (two-week order windows) We encourage you to do it

27. 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

28. EOQ: When to order Current order pattern: Spikes at beginning of month (inefficient) Doses (M) Memphis Distribution Center Sacramento Distribution Center

29. EOQ: When to order (two-week order windows) Desired: smooth order flow throughout the month Illustrative Doses (M) Memphis Distribution Center Sacramento Distribution Center

30. 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

31. 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

32. EOQ Tools: Provider Ordering Calendar Two-week order windows Illustrative

33. EOQ Ordering Tool • Your inputs: • On-hand inventory • Refrigerator size • Preloaded inputs: • Order frequency • Five-week safety stock • Past distribution data • Seasonality Recommended order quantity

34. 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

35. 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…

36. GPE Toolboxes • Provider 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

37. EOQ and GPE: Participating Grantees Maine Wisconsin New York New York City Philadelphia Chicago District of Columbia Kentucky Oklahoma Arkansas New Mexico Hawaii Texas Alabama San Antonio Houston Guam Marshall Islands N. Mariana Island EOQ+GPE Republic of Palau American Samoa EOQ only Micronesia GPE only

38. 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

39. For more information, please contact… Julie OrtaVMBIP Assistant Leadjulie.orta@cdc.hhs.gov …and please copy your POB project officer

40. Table of Contents • 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)

41. 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

42. 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

43. VTrckS: Grantee Features • 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

44. VTrckS: Grantee Features • 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

45. VTrckS: Implementation when? Depends on analysis in progress Deployment tentatively planned summer 2010 Release 1 functionality

46. Table of Contents • 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)

47. 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 Period Continued Provider Transition Eval. and Feedback Period ½ of the remaining grantees Wave 1 Remaining Grantees Continued Provider Transition 46 Wave 2

48. 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

49. 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

50. 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