1
Program Managers Meeting
New Orleans, LA
November 18, 2008
Vaccine Management Business Improvement Project(VMBIP)
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
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
3
4
VMBIP Overview
Distribution Provider Ordering
Stockpile
VTrckS SupportVTrckS SupportDistribution SupportDistribution Support
Supply chain management expertise
Inventory management and distribution economics
Distribution contract best-practices
Supply chain management expertise
Inventory management and distribution economics
Distribution contract best-practices
Stockpile SupportStockpile Support
Financial analysis and recommendations for transition timelines and seasonality factors
Financial analysis and recommendations for transition timelines and seasonality factors
VMBIP
Internal Efficiencies Support
Continuous Quality Improvement Initiatives– Internal to CDC– Grantee-facing– Between CDC and McKesson
Funds Monitoring, Management, and Analysis
Grantee Funds Management Workforce Analysis
Continuous Quality Improvement Initiatives– Internal to CDC– Grantee-facing– Between CDC and McKesson
Funds Monitoring, Management, and Analysis
Grantee Funds Management Workforce Analysis
Project Management for Blueprinting, Testing, Piloting, and Implementation Phases
Stakeholder Management and Communications
Organizational Change Management
Contact Center Help Desk Design and Implementation
Data Migration Strategy
Project Management for Blueprinting, Testing, Piloting, and Implementation Phases
Stakeholder Management and Communications
Organizational Change Management
Contact Center Help Desk Design and Implementation
Data Migration Strategy
Distribution Provider Ordering
Stockpile
VTrckS SupportVTrckS SupportDistribution SupportDistribution Support
Supply chain management expertise
Inventory management and distribution economics
Distribution contract best-practices
Supply chain management expertise
Inventory management and distribution economics
Distribution contract best-practices
Stockpile SupportStockpile Support
Financial analysis and recommendations for transition timelines and seasonality factors
Financial analysis and recommendations for transition timelines and seasonality factors
VMBIP
Internal Efficiencies Support
Continuous Quality Improvement Initiatives– Internal to CDC– Grantee-facing– Between CDC and McKesson
Funds Monitoring, Management, and Analysis
Grantee Funds Management Workforce Analysis
Continuous Quality Improvement Initiatives– Internal to CDC– Grantee-facing– Between CDC and McKesson
Funds Monitoring, Management, and Analysis
Grantee Funds Management Workforce Analysis
Project Management for Blueprinting, Testing, Piloting, and Implementation Phases
Stakeholder Management and Communications
Organizational Change Management
Contact Center Help Desk Design and Implementation
Data Migration Strategy
Project Management for Blueprinting, Testing, Piloting, and Implementation Phases
Stakeholder Management and Communications
Organizational Change Management
Contact Center Help Desk Design and Implementation
Data Migration Strategy
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
CQI Project Accomplishments
Cold Chain Study - Closed
• McKesson has hired dedicated FTEs to monitor VMBIP package movement throughout the nation
• McKesson has implemented additional review activities to improve the cold chain processes• McKesson has qualified all pack-out designs for all shipping containers, including both hot
and cold ambient temperatures
Product Shipment Integrity - Ongoing
• McKesson has updated their training program to monitor manual processes via the Quality Control program
• Improved vaccine pick stations to include pack-out diagrams and consolidated order ticket distribution activities and increased team lead responsibility
CA Efficiencies - Closed
• Enhanced grantee order processes and accountability methods in support of a more streamlined order processing system
• Created standardized tools to support order receipt, order submission, and storage policies at the provider’s office
Influenza Vaccine - Closed
• Identified and disseminated grantee best practices around preplanning for flu vaccine orders• Developed an allocation system to manage grantee orders provide grantees with daily
balances • Import/export file support to allow grantees to preplan outside the system and then upload
their files when they receive their allocation
9
Data, Systems, and Reporting CQI Initiatives
CQI Project Status Description Accomplishments
Data, Systems, and Reporting (DSR) – Phase One
ClosedMay 1
Create a baseline of the data touch points, reports, and systems involved with VMBIP
•Created systems architecture diagram to understand the inputs and outputs of VMBIP•Reports matrix was created to provide visibility into the data outputs of the program
Data, Systems, and Reporting – Phase Two
Open
iDoc Error Report (McKesson) – Create a report to monitor the volume of iDoc errors for a given period to provide a gauge of data quality (ship dates, inventory levels, etc.) between SAP and TecSys
Data, Systems, and Reporting – Phase Two
Data, Systems, and Reporting (DSR) – Phase Two
Closed Sep 18
Legacy Systems Call Type Report – Create a report to provide visibility into the types of calls related to VACMAN to better understand grantee concerns or system issues
•Call activity report was created and is delivered monthly to VACMAN leadership to better understand current call types and address issues
Closed Nov 4
Reports Review – Interview recipients of VMBIP distribution data to determine if user’s needs are met. If gaps are identified present them to the Change Control Board for review
• Interviewed CDC and Grantee representatives to identify reporting needs, successes, and deficiencies
• Identified 77 changes that would fill the identified gaps in the reports currently in use by CDC and the Grantees
• The Reporting Change Control Board will evaluate the change requests to determine if they should be incorporated into the program
10
Grantee/Provider Efficiency CQI
GranteesGrantees
• Grantees can be provided the tools and methods to improve internal efficiencies by understanding their labor requirements and communicating real performance
• Grantees can be provided the tools and methods to improve internal efficiencies by understanding their labor requirements and communicating real performance
ProvidersProviders
• Providers can benefit by implementing operational best practices to improve efficiencies and accountability
• Providers can benefit by implementing operational best practices to improve efficiencies and accountability
Field RepresentativesField Representatives
• Field Representatives will be better equipped to support the providers’ vaccine storage needs for their assigned providers and reduce wastage
• Field Representatives will be better equipped to support the providers’ vaccine storage needs for their assigned providers and reduce wastage
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.
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.
11
Economic Order Quantity
The original TOF guidelines have been updated, based on recent provider ordering data, collected from all transitioned grantees
New EOQ Guidelines
As-is
4
6
12
Orders per Year
0-199
200-799
800-5,999
6,000+
Annual Volume
(Doses/ Year)
As-isVery Low Volume
QuarterlyLow Volume
Bi-monthlyMedium Volume
MonthlyHigh Volume
Order Cycle
Provider Segment
As-is
4
6
12
Orders per Year
0-199
200-799
800-5,999
6,000+
Annual Volume
(Doses/ Year)
As-isVery Low Volume
QuarterlyLow Volume
Bi-monthlyMedium Volume
MonthlyHigh Volume
Order Cycle
Provider Segment
As-is
4
6
12
Orders per Year
0-99
100-499
500-1999
2000 +
Annual Volume
(Doses/ Year)
As-isVery Low Volume
QuarterlyLow Volume
Bi-monthlyMedium Volume
MonthlyHigh Volume
Order Cycle
Provider Segment
As-is
4
6
12
Orders per Year
0-99
100-499
500-1999
2000 +
Annual Volume
(Doses/ Year)
As-isVery Low Volume
QuarterlyLow Volume
Bi-monthlyMedium Volume
MonthlyHigh Volume
Order Cycle
Provider Segment
Original TOF Guidelines
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
Pilot EOQ GranteesNYC, Florida, Pennsylvania, and Oregon
FloridaFlorida
PennsylvaniaPennsylvania
NYCNYC
OregonOregon
FloridaFlorida
PennsylvaniaPennsylvania
NYCNYC
OregonOregon
Centralized Distribution
• Transition of Centralized Distribution Support
• Transmission of Orders from CDC
• Flu vaccine ordering/distribution
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
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.
0
5,000
10,000
15,000
20,000
25,000
30,000
1-Sep
4-Sep
9-Sep
12-S
ep
17-S
ep
22-S
ep
25-S
ep
30-S
ep3-
Oct
8-O
ct
14-O
ct
17-O
ct
22-O
ct
27-O
ct
9/9 – CDCSDN Issue
10/13 – Columbus Day9/12 - 9/26 – Orders Held For Hurricanes
73.3%
91.3%
52.2%
69.1%
86.4%
69.7%
82.3%
55.0%
Non Flu Work Queue at McKesson
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
Daily Flu Allocation Balance Report
Grantee Vaccine NDC Season Avail Approved Held Bal
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
Example
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
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
04/21/23 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
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
VACMAN UPDATERelease Status
VERSION NUMBER
RELEASE DATE
DATE ISSUE FOUND
ISSUE
4.1.4 7/7/08 7/11/08 Bug in code would not process orders for vaccines with three or less characters in the name
4.1.4.1 8/28/08 9/15/08 Bug in VACMAN communications would not process flu vaccine orders. Workaround was to import flu orders into VACMAN.
4.1.4.2 9/17/08 N/A Validate order process causing too many issues with rejected orders file.
4.1.4.3 TBD Turn off the second validate order process that was rejecting orders.
VACMAN UPDATERelease Status
• CORRECTIVE ACTIONS– CONTROL SOURCE CODE – DEVELOP COMPREHENSIVE TEST PLAN
-- FULL REGRESSION TESTING– INDEPENDENT TESTER FOR QUALITY ASSURANCE
VACMAN UPDATEGrantee Questions/Comments
VACMAN reports generated/exported to Excel cuts off after 16,800 records
This is a limitation of Excel. You may want to export using a .dbf and MS Access.
When transmitting orders, internal staff name is on screen. After transmission, it changes to CDC. If staff are making errors during this process, we are unable to coach them in the proper procedures.
A Change Request will be opened for this enhancement, and presented to the next VACMAN Change Control Board.
VACMAN will not allow identical number of doses for the same vaccine type (e.g., cannot order 10 Boostrix and 10 Adacel) for the same provider.
The development team tested this scenario on the provider order screen, the multi-order order screen and import feature in both VACMAN 4.1.4.2 and VACMAN 4.1.4.3. We were unable to replicate; VACMAN saved both TDAP orders.
Flu email notifications Researching report of non-receipt of this info
VACMAN statuses are 2 weeks behind and sometimes orders are placed on backorder but are cancelled before the backorder status is received in VACMAN.
It is possible that a vaccine order placed on backorder will either be received and shipped or cancelled before the statuses in VACMAN sync up.
High-level architecture of the VMBIP environment, including CDC and McKesson IT systems
VACMAN UPDATEGrantee Questions/Comments
Business Day 1 CDC Receives Orders from Grantees
Business Day 2 CDC Processes Orders
McKesson Picks Up Order File
Business Day 3 McKesson Picks, Packs, and Ships
Business Day 4 McKesson Sends Shipping (Receipt) File to CDC
Business Day 5 CDC Processes Receipt File
Grantee Gets Information Upon Download from CDC
OPTIMUM TIMELINE FROM ORDER TO RECEIPT (SHIPPING) INFORMATION
VACMAN UPDATEGrantee Questions/Comments
ACTUAL ORDER TO RECEIPT TIMELINE
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
VACMAN SUMMARY
• VACMAN/NIPVAC STATISTICS
• VACMAN UPDATE
• CONTINUOUS QUALITY IMPROVEMENT