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

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Presentation on theme: "DRAFTDRAFT DRAFTDRAFT Program Managers Meeting Atlanta, GA January 21, 2010 Vaccine Management Business Improvement Project (VMBIP)"— Presentation transcript:

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

2 DRAFTDRAFT DRAFTDRAFT 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 1

3 DRAFTDRAFT DRAFTDRAFT 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 2

4 DRAFTDRAFT DRAFTDRAFT VMBIP addresses all critical aspects of public sector vaccine management Vaccine Distribution Vaccine Tracking System (VTrckS) Stockpile Management Internal Efficiencies 3

5 DRAFTDRAFT DRAFTDRAFT 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 4

6 DRAFTDRAFT DRAFTDRAFT 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 5

7 DRAFTDRAFT DRAFTDRAFT 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 6

8 DRAFTDRAFT DRAFTDRAFT 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 7

9 DRAFTDRAFT DRAFTDRAFT Todays 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) 8

10 DRAFTDRAFT DRAFTDRAFT 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 9

11 DRAFTDRAFT DRAFTDRAFT 10 Centralized Distribution: Topics Overview Seasonal Flu Distribution Customer Service Lessons learned from liability reviews Reminder about needle returns

12 DRAFTDRAFT DRAFTDRAFT 11 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 DRAFTDRAFT DRAFTDRAFT 12 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 DRAFTDRAFT DRAFTDRAFT 13 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 DRAFTDRAFT DRAFTDRAFT 14 Seasonal Flu Distribution, III Order PlacedOrder Received at DistributorOrder Shipped Out FridayMondayWednesday MondayTuesdayThursday TuesdayWednesdayMonday WednesdayThursdayTuesday ThursdayFridayWednesday Shipping Schedule 09-10 Flu Season Metrics >=95%93-94.9%<93%Daily order lines >625K doses GreenYellowRedWhite

16 DRAFTDRAFT DRAFTDRAFT 15 Customer Service February contract modification defined metrics for customer service Customer service tickets fully resolved within 24 business hours Priority #18 business hours Priority #216 business hours Priority #324 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 DRAFTDRAFT DRAFTDRAFT 16 Customer Service Call TopicPriority Group HD Resolvable Customer Service Tickets

18 DRAFTDRAFT DRAFTDRAFT 17 Customer Service

19 DRAFTDRAFT DRAFTDRAFT Performance Metrics *December metrics are preliminary.

20 DRAFTDRAFT DRAFTDRAFT 19 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 DRAFTDRAFT DRAFTDRAFT 20 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, dont remember they ordered, appear damaged Providers are not available during stated office hours Vaccine is delivered outside of stated office hours

22 DRAFTDRAFT DRAFTDRAFT 21 Unsafe Vaccine Returns Continue to Occur Thank you for continuing to follow up with and educate your providers on this important issue.

23 DRAFTDRAFT DRAFTDRAFT 22 For more information, please contact… Cameron Noblit (cnoblit@cdc.gov)cnoblit@cdc.gov –Team Lead, Vaccine Supply and Distribution Team Sally Somerfeldt (ssomerfeldt@cdc.gov)ssomerfeldt@cdc.gov –Project Officer, Distribution Contract Helen Kuykendall (hkuykendall@cdc.gov)hkuykendall@cdc.gov –Project Officer, Distribution Contract Lisa Galloway (lgalloway@cdc.gov)lgalloway@cdc.gov –Project Officer, Distribution Contract Jeanne Santoli (jsantoli@cdc.gov)jsantoli@cdc.gov –Acting Chief, Vaccine Supply and Assurance Branch …and please copy your POB project officer

24 DRAFTDRAFT DRAFTDRAFT 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 23

25 DRAFTDRAFT DRAFTDRAFT 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 24

26 DRAFTDRAFT DRAFTDRAFT 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 25

27 DRAFTDRAFT DRAFTDRAFT 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 FrequencyAnnual Vaccine Doses Monthly6,000 or more Bimonthly800 – 5,999 Quarterly200 – 799 As Needed199 or less 26

28 DRAFTDRAFT DRAFTDRAFT EOQ: When to order Doses (M) Memphis Distribution CenterSacramento Distribution Center Current order pattern: Spikes at beginning of month (inefficient) 27

29 DRAFTDRAFT DRAFTDRAFT EOQ: When to order (two-week order windows) Doses (M) Memphis Distribution CenterSacramento Distribution Center Illustrative Desired: smooth order flow throughout the month 28

30 DRAFTDRAFT DRAFTDRAFT EOQ: Whats in it for me? Overall fewer orders to process Improved ability to order right quantity for your providers Spread workflow throughout the month 29

31 DRAFTDRAFT DRAFTDRAFT 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 30

32 DRAFTDRAFT DRAFTDRAFT EOQ Tools: Provider Ordering Calendar Two-week order windows Illustrative 31

33 DRAFTDRAFT DRAFTDRAFT Your inputs: –On-hand inventory –Refrigerator size Preloaded inputs: –Order frequency –Five-week safety stock –Past distribution data –Seasonality EOQ Ordering Tool Recommended order quantity 32

34 DRAFTDRAFT DRAFTDRAFT 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 33

35 DRAFTDRAFT DRAFTDRAFT GPE: Whats in it for me? All the benefits of EOQ Plus the benefits of other industry best practices on your entire vaccine order/review system… 34

36 DRAFTDRAFT DRAFTDRAFT 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 35

37 DRAFTDRAFT DRAFTDRAFT New Mexico Texas Oklahoma Arkansas Alabama Kentucky Wisconsin New York Maine Philadelphia Hawaii GuamMarshall Islands Republic of Palau Micronesia American Samoa N. Mariana Island San Antonio Chicago New York City Houston EOQ+GPE EOQ only GPE only District of Columbia EOQ and GPE: Participating Grantees 36

38 DRAFTDRAFT DRAFTDRAFT 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 37

39 DRAFTDRAFT DRAFTDRAFT For more information, please contact… Julie Orta VMBIP Assistant Lead julie.orta@cdc.hhs.gov julie.orta@cdc.hhs.gov …and please copy your POB project officer 38

40 DRAFTDRAFT DRAFTDRAFT 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 39

41 DRAFTDRAFT DRAFTDRAFT 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 40

42 DRAFTDRAFT DRAFTDRAFT 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 41

43 DRAFTDRAFT DRAFTDRAFT 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 42

44 DRAFTDRAFT DRAFTDRAFT 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 43

45 DRAFTDRAFT DRAFTDRAFT VTrckS: Implementation when? Depends on analysis in progress Deployment tentatively planned summer 2010 Release 1 functionality 44

46 DRAFTDRAFT DRAFTDRAFT 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 45

47 DRAFTDRAFT DRAFTDRAFT 46 VTrckS Release 1: Proposed Rollout Strategy Go-Live CDC back office function users VPOP Grantees Volunteer Grantees and Provider Transition Six-month Pilot Period ½ of the remaining grantees Remaining Grantees Continued Provider Transition Wave 1 Wave 2 Eval. and Feedback Period Continued Provider Transition 46

48 DRAFTDRAFT DRAFTDRAFT 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 47

49 DRAFTDRAFT DRAFTDRAFT 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 48

50 DRAFTDRAFT DRAFTDRAFT 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 49

51 DRAFTDRAFT DRAFTDRAFT 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 50

52 DRAFTDRAFT DRAFTDRAFT TopicVPOP VTrckS (various releases) Participants Four grantees and select providers All grantees and providers, at the grantees discretion ExIS/IIS IntegrationNoYes VACMAN UseYesNo Order Status Limited to order confirmation Order confirmation to shipment information Grantee AccessNoYes Provider online ordering/submission of accountability data Yes VPOP: How does VPOP differ from VTrckS? 51

53 DRAFTDRAFT DRAFTDRAFT 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 52

54 DRAFTDRAFT DRAFTDRAFT VPOP: Ordering activity Grantee Go-live Date Active provider sites/usersOrders MassachusettsMay 20 58/77106 CaliforniaJune 1 16/3476 ChicagoJune 15 105/197272 ColoradoJuly 6 37/41185 Total 216/349645 May 18, 2009 - Dec 31, 2009 53

55 DRAFTDRAFT DRAFTDRAFT VPOP: Overall project success criteria Grantee 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 deemed critical by the VPOP user community 54

56 DRAFTDRAFT DRAFTDRAFT 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 55

57 DRAFTDRAFT DRAFTDRAFT 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 56

58 DRAFTDRAFT DRAFTDRAFT 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 57

59 DRAFTDRAFT DRAFTDRAFT 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 users identity –Create materials to educate and guide end users through the process –Improve the grantees ability to monitor the status of providers in the identity proofing process 58

60 DRAFTDRAFT DRAFTDRAFT 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 59

61 DRAFTDRAFT DRAFTDRAFT 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 60

62 DRAFTDRAFT DRAFTDRAFT 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 61

63 DRAFTDRAFT DRAFTDRAFT 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 62

64 DRAFTDRAFT DRAFTDRAFT 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 63

65 DRAFTDRAFT DRAFTDRAFT 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 64

66 DRAFTDRAFT DRAFTDRAFT 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 65

67 DRAFTDRAFT DRAFTDRAFT VTrckS GAC: Where are we now? The GAC continues to meet monthly to maintain VTrckS communication between grantees and CDC 66

68 DRAFTDRAFT DRAFTDRAFT 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 input 67

69 DRAFTDRAFT DRAFTDRAFT 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 68

70 DRAFTDRAFT DRAFTDRAFT For more information, please contact… Kyle Wickes VTrckS Lead kyle.wickes@cdc.hhs.gov kyle.wickes@cdc.hhs.gov Joe McDowell IT Project Manager joe.mcdowell@cdc.hhs.gov joe.mcdowell@cdc.hhs.gov Brad Prescott VMBIP Lead brad.prescott@cdc.hhs.gov brad.prescott@cdc.hhs.gov Nathan Crawford VTrckS Grantee Advisory Committee Lead ncrawford2@cdc.gov ncrawford2@cdc.gov …and please copy your POB project officer 69

71 DRAFTDRAFT DRAFTDRAFT Questions? 70


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