PharmD, Director – Pharmacy/Non-Acute Sourcing, Universal Health Services
October 2023- The Journal of Healthcare Contracting
JHC: Where does non-acute, alternate site care fit into our nation’s healthcare continuum?
Lori Daukas: Non-acute/alternate site healthcare is an integral part of our daily lives. The category encompasses such diverse practice settings as behavioral health services (including residential and outpatient treatment centers), multi-specialty physician clinics, urgent care centers, ambulatory surgery centers, and telemedicine services. These sites are often more convenient and less expensive for patients, meaning that a larger, more diverse patient population can access healthcare. Finally, use of these sites frees up our hospitals and emergency rooms for those patients who require a more acute level of care.
During the pandemic, these care settings became even more essential. The demand for behavioral health services increased exponentially as the pandemic wore on. Although we have moved beyond the pandemic, the need for quality behavioral health services continues to increase. Telemedicine came into its own in the last few years as practices across the country discovered ways to connect with their patients to provide care, yet limit exposure to infectious disease. Urgent care settings became more appealing to patients who were anxious about going to an emergency room during a pandemic. To me, it’s a bit of a pandemic silver lining that we were able to significantly advance our ability to reach more patients in more isolated areas through these non-traditional solutions.
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?
Daukas: Universal Health Services (UHS) has a long history of understanding and leading healthcare trends in acute and non-acute care settings. Since its inception in 1979, UHS has been an industry leader focused on synergizing acute healthcare and mental health needs for all patient populations. As a leader in behavioral health, UHS has increased our alternate site offerings, allowing us to provide care to a more diverse patient population, no matter the level of acuity. For example, we are leveraging technology to better integrate our acute care and behavioral health hospitals through a single, unified electronic health record. We continue to expand our presence in terms of urgent care centers, ambulatory surgery centers, and physician practices. This growth, combined with a greater level of telemedicine services, will allow us to continue to provide superior care, especially to populations who are underserved.
JHC: How do you measure success in non-acute supply chain initiatives that may differ from acute?
Daukas: From a base supply chain perspective, the measurements are the same. However, our sourcing and distribution strategies are dramatically different for our alternate care sites. It’s important to remember that alternate sites are not just “acute care-lite.” I oversee supply chain for over 400 UHS Non-Acute sites that span 39 states, D.C., and Puerto Rico and encompass a wide range of services, patient ages, and levels of acuity. They may be located in a space which poses unique challenges regarding product delivery and storage and may require specialized products.
Because we serve a large number of Behavioral Health hospitals and clinics, the non-acute supply chain team is aware of and manages product safety concerns that must be taken into consideration. All products must be evaluated for potential risk of harm to the patient or to others. We work with our clinicians and our vendors to build solutions that suit the needs of our sites. We also work diligently to ensure that any processes we put in place are practical and sustainable. Most alternate sites have fewer onsite resources than an acute care hospital and require a scaled down, streamlined approach.
Being able to secure product at competitive pricing is as important in the non-acute space as it is in the acute space. When we are able to provide the right product at the right time at the right price to our clinicians, operators, and patients, our most valuable measures have been met.
JHC: What is a recent project (or upcoming one) related to non-acute you are excited to work on?
Daukas: During COVID, we discovered that we had little transparency into the level of PPE stocked at our many behavioral health facilities. Working with our internal IT team, we identified and built a tool that allows the Behavioral Health sites to monitor their PPE levels in relation to established PAR levels. The system emails reminders to sites, when necessary. We also built in redundant messaging to capture staffing changes. In addition to providing visibility into PPE supply on hand, this tool serves as a reminder that all our facilities must be prepared for an unexpected infectious outbreak.
We also recently developed a product formulary for our behavioral health facilities and are continuing to expand the product categories. UHS operates over 300 behavioral health entities, and we were seeing a lot of variation in ordering practices. We wanted to begin standardization initiatives but will not sacrifice safety for cost savings. We were unable to find an existing behavioral health product formulary, so we decided to build our own, using our large behavioral health footprint as a source of information.
To build the core formulary, we evaluated the products our sites order on a category-by-category basis. Product samples were reviewed by value analysis professionals familiar with the behavioral health space, and our behavioral health nursing leadership served as a resource for questions. This is our ongoing process as we continue to expand the formulary categories. Once products are identified that satisfy our quality and safety needs, we begin pricing discussions to capture savings. There are feedback mechanisms built into our process to ensure that the list is maintained over time.
Our goal is a complete formulary of products that will both support the needs of our hospitals and provide them with cost savings. It’s a challenging task, but very satisfying and exciting for our team to be creating something new that supports the delivery of high-quality patient care.
JHC: What skills are essential for supply chain leaders today?
Daukas: First and foremost is a focus on the end users – our patients and our clinicians. I come from a clinical background, so this is very near and dear to my heart. Our patients and their care providers are the reason we do what we do. At the end of the day, it’s important to me to know we have made ethical decisions in support of quality patient care. I appreciate working for UHS because this is one of the tenets of our mission statement.
I also place a high value on things like emotional intelligence and empathy. These qualities are essential when building relationships, negotiating contracts, and navigating day to day issues like shortages and allocations. Additional lessons learned from navigating the pandemic include the need for resourcefulness, grit, and resilience. Finally, there is the need to be nimble. Unexpected challenges are routine in supply chain, and we need to be able to recover, adapt, and move forward on a regular basis.
These are important skills for everyone on the supply chain team, not just leaders. As leaders, we have a responsibility to instill in our teams a sense of accountability and a realization that what we do is important on a very personal level. Whatever method is chosen – educational sessions, one-on-ones, group discussions – we need to make time to develop our team members and give them opportunities to grow. Supply Chain has never been more important than it is today, and there will be an ongoing need for leaders who can continue to move healthcare into the future.
JHC: In your experience, what are some keys to a successful partnership between suppliers and providers?
Daukas: Strong relationships are key. That’s the foundation for finding win-win solutions when issues arise. Introductory calls or face-to-face meetings are a great way to connect and set mutual goals and expectations. From there, I set up regular cadence calls with my primary distribution vendors. We use those calls to check in, track ongoing projects, identify problem areas, and celebrate our wins together. Establishing a sense of teamwork has helped us work more productively toward our common goals. Process improvement discussions are frequent, and we set up a dedicated workgroup to address any significant service issues. I make sure to verbalize what’s going well so we can build on that as we address opportunities for improvement.