Karla J. Butts

Executive director, client executive team, The Resource, Engineering, and Hospitality Group, Providence St. Joseph Health, Renton, Washington

Karla J. Butts

The Journal of Healthcare Contracting: Why do you believe non-acute, alternate site locations are vital to not only a health system or IDN, but U.S. health care in general?

Karla Butts: Health equity is a great concern for me personally and I believe non-acute/alternative locations help bridge the gap. These locations expand the clinical reach and support to communities where logistics alone may present a barrier to access care. By providing increased access, we build a coordinated care network for patients to ease their care
planning and provide an opportunity to reach their full health potential.

At Providence, our promise is Know Me, Care for Me, Ease My Way. For our organization our non-acute/alternative locations are vital in delivering on this promise; delivering high quality care directly in the communities we serve, providing the right level of care for every event and stage of life.

JHC: What are some keys to success for supply chain teams that may be unique to non-acute?

Butts: Non-acute systems can be a large footprint, so pushing out uncontrolled variation and inefficiencies through modernized approaches in product standardization, single channel distribution models, and leveraging data and analytics are key to overall non-acute supply chain success. Having a cross-functional supply chain team that incorporates end to end service delivery – inclusive of all functions from procure to pay has proved to be successful as we expand our footprint within our own non-acute space.

Another key is understanding the inherent complexities of this space. Non-acute locations are often comprised of multiple groups and providers serving several locations, delivering diverse levels of care over large geographical footprints. Our organization has over 1,000 combined locations covering seven states that include clinics, ASCs, and post-acute service lines. It is critical to understand the overall supply chain needs and potential barriers including logistical concerns for these locations. This level of understanding and familiarity with our locations drives how we design our overall non-acute strategy.

Understanding how vendors serve in this environment is another key factor. Recognizing not all vendors support or seek out non-acute footprints or if they do, they may have different pricing, distribution models, and service offerings that are separate from our acute agreements. This is an important consideration when shaping your strategy.

JHC: How was your department affected by COVID-19? What type of disruptions did you see? How were you able to navigate?

Butts: As with all areas of healthcare we saw the largest disruption in PPE availability. To add to the challenge, we had to prepare to provide large volumes of PPE in a short period of time to sites that have historically not used full PPE including N95s as part of their day-to-day practice. The disruption also extended to items needed to properly sanitize locations to keep our patients and caregivers safe.

Another challenge was having real-time visibility to locations’ on-hand inventory. Visibility is different from that of an acute setting; non-acute sites often do not have real-time inventory data feeds. To respond, we had to quickly gain an understanding of what the overall potential demand was going to be for established locations but also be fluid in planning for setting up alternative testing sites as well as influxes in volumes that could shift within 24 hours in some markets.

To navigate these disruptions, we partnered with our strategic partners on a distribution model that was transparent and when needed we engaged in new relationships to source from new vendors (locally and globally) to bridge the gap. We created a pandemic forecasting tool to understand inbound and anticipated demand incorporating the patient volume data from our system to anticipate changes in volume trends. We also navigated demand planning by standing up processes to account for volumes needed in the non-acute space to navigate the increased demand due to little to no historical utilization of specific items. 

JHC: Has the perception/integration by executive leadership of alternate sites within a health system or IDN changed in the last few years? If so, could you explain?

Butts: I do believe the perception/integration has expanded over the last few years, understanding that the needs of our patients and communities are evolving and to meet that demand so must our delivery model. Historically care for patients has been centered at the acute facility level, but now we are seeing that model being deconstructed and remodeled around the patient and their needs by creating an overall delivery care model for our patients.

To meet that new model, we have added resources to our supply chain functional teams specifically to support non-acute service lines including client services, sourcing, procurement, operations and logistics just to name a few. We recognize the opportunity that presents for our customers and patients by building and supporting a holistic supply chain network.

JHC: What project or initiative are you looking forward to implementing now or in the near future?

Butts: We have a few exciting projects launching soon. One is launching a system formulary in our non-acute settings that will reduce variation, cost, and align to our continuum of care model.

We are also an expanding organization and have built an onboarding standards model that can be deployed for our express care and urgent care locations currently but will be expanding into other non-acute/alternative sites this year. Our standards model includes a multi-functional planning team, standardized formulary/product standards list, and a coordinated “white glove” site set up.

As we continue to expand our footprint, we are continually designing modernized processes and offerings to our network that connects them to our full portfolio available from within our supply chain functional teams.