# Presentation: 142703

## Program Managers Meeting
Atlanta, GA
November 8, 2007

**Atlanta, GA**
**November 8, 2007**

**Vaccine Management Business Improvement Project****(VMBIP)**

## VMBIP Project Lead

## Today’s Agenda

- VMBIP – Lance Rodewald and Brad Prescott
- Provide a brief overview and update of VMBIP
- Review issues and resolutions
- Review the new grantee transition schedule
- Provide lessons learned and important process changes
- Give a brief overview of the Continuous Quality Improvement (CQI) analysis
- VODS/VaX.NET – Janet Kelly
- VODS Update
- Plan for Reengaging Grantees
- McKesson – Terry Fox, Tom Hart, and Jake Frost
- Updates
- Enhancements
- Questions

## Slide 4

## As of Oct 31, 34 grantees have transitioned to McKesson resulting in over 22.7M doses shipped to providers

| Criteria | Total |
| --- | --- |
| Number of grantees transitioned | 34 |
| Percent of program volume transitioned | 60% |
| Total orders shipped since February 2007 “go-live” | 85,827 |
| Total doses shipped since February 2007 “go-live” | 22,714,981 |

**All Vaccines Shipment Summary as of October 31**

*Note: An order is defined as all vaccine orders for a given provider on a given day*
*Source:  NIPVAC processed provider shipment data*

| Criteria | Total |
| --- | --- |
| Total doses ordered since start of 2007/2008 flu season | 4,222,016 |
| Total doses shipped since start of 2007/2008 flu season | 3,985,040 |
| Doses ordered but not yet shipped | 236,976 |
| Doses remaining in inventory and not ordered | 1,587,964 |

**Flu Shipment Summary as of November 5**

## WE ACKNOWLEDGE THAT THERE HAVE BEEN MANY CHALLENGES

## Issues raised on August 22 AIM call (1 of 2)

| Issue | Description |
| --- | --- |
| Vaccine Delivery Times  | McKesson vaccine shipments to providers are averaging two to three weeks
AIM members believe the primary reason is due to the five-day shipping language in the contract |
| Order Accuracy | Several projects report a “high” frequency of lost and/or inaccurate orders
Grantees claim that upon receipt of an inaccurate order, the provider was requested to return the viable vaccine to McKesson  |
| Order Shipments | Grantees reporting split shipments, multiple boxes for small orders, and diluents being shipped separate from MMR
Some shipments are arriving without temperature monitor devices or with monitor reading “Not OK” |
|  | Grantees do not know, in a timely manner, when vaccine is shipped to providers |
| Customer Service | Grantees report that McKesson is not returning phone calls within 2-day allotted time period or at all
Grantees reporting inconsistency of information received |
| Non-viable Vaccine Returns | Many grantees are not clear on the process for returning wasted or expired vaccine |

## Issues raised on August 22 AIM call (2 of 2)

| Issue | Description |
| --- | --- |
| Box Markings and Returns | Grantees reporting UPS will not pick up empty boxes to return to McKesson or else will charge a $10 pick-up fee |
| Priority Order Limits | Are grantees being held to the 2% priority order limit?
What happens if a state goes over its allocation of 2%?
Will they be allowed to go over and if so, will that interfere with other states’ orders or only the state with the priority orders? |
| Influenza Vaccine Shipping | How will orders be placed based on availability of National Supply?
How will providers on TOF place orders?
How will availability be communicated?
How will the order be shipped and reported?
What is the process for returning viable vaccine? |
| Vaccine Data Information | Not timely distribution of receipt data |

## Additional VMBIP CDC Challenges

- No or Limited data
- Lack of Data Warehouse
- Grantee Monitoring and Replenishment Reports delayed or inaccurate
- No performance data
- VACMAN/NIPVAC challenges
- VODS Delay

## What are we doing to address these challenges?

- Using alternate data sources to monitor performance and communicate results to grantees
- Testing automated Grantee Monitoring and Replenishment reports to speed up process and eliminate errors
- VACMAN releases each quarter
- VODS production resumed
- Regularly scheduled CDC and McKesson meetings to formulate and implement solutions
- CQI Study and Implementation
- Major enhancements at McKesson
- Pause in rollout schedule

## With input from McKesson and grantees, we are slowing implementation for the remaining grantees

## McKesson Enhancements

- Customer Service Center
- Additional staff
- Flu only shipping line
- Temperature monitor change
- Master Packing List
- Daily Shipping Report
- Welcome Packet
- Sacramento distribution center – early January

## All of the processes are currently working but revealed opportunities for key modifications 
The overall process could benefit from:
Providers:
Standardizing and using best practices for vaccine inventory management
Teaching providers how to accurately complete forms and the importance of vaccine inventory management
Grantee (CA):
A process that balances vaccine accountability processes and expedited order flow
Evaluate current order form
McKesson:
A second picking line (already in progress)
Real-time productivity and quality performance feedback to teams
Enhanced communications with the customer service team
Increased data capture and usage in the customer service process

- All of the processes are currently working but revealed opportunities for key modifications
- The overall process could benefit from:
- Providers:
- Standardizing and using best practices for vaccine inventory management
- Teaching providers how to accurately complete forms and the importance of vaccine inventory management
- Grantee (CA):
- A process that balances vaccine accountability processes and expedited order flow
- Evaluate current order form
- McKesson:
- A second picking line (already in progress)
- Real-time productivity and quality performance feedback to teams
- Enhanced communications with the customer service team
- Increased data capture and usage in the customer service process

## For each accepted recommendation, an appropriate process owner should be assigned and timelines established for execution

Evaluate recommendations and determine a path forward for each

Determine appropriate role for CQI team on executing recommendations presented in this document -- We recommend assisting with “deep dives” in: 
Provider inventory management process development and training 
Order form refinement
Accountability process development
Temperature monitoring trends
Assist in evaluation of SharePoint and return data

- For each accepted recommendation, an appropriate process owner should be assigned and timelines established for execution
- Evaluate recommendations and determine a path forward for each
- Determine appropriate role for CQI team on executing recommendations presented in this document -- We recommend assisting with “deep dives” in:
- Provider inventory management process development and training
- Order form refinement
- Accountability process development
- Temperature monitoring trends
- Assist in evaluation of SharePoint and return data

## For transitioned and non-transitioned grantees, we have listed several lessons learned and other process changes

**Confirm** the list of vaccine presentations that will be used to ensure the seed orders are accurate and complete
- Ensure provider open hours and address **are correct** so shipments can be delivered
- Complete and email the **Excel spreadsheet** to the email addresses listed in the instructions tab for **all** 317 FA and state funded bulk orders
**Check the temperature monitor** in the box immediately after the shipment is received
- Ensuring grantee IT staff is available **the full week prior to go-live** to work through any technical issues that may come up during the transition period

## On October 31, an important “all-grantee” message was distributed to the program managers

- The anticipated switch from the electronic temperature monitors to the chemical monitors
- Effective immediately, only use the _[vaccinedistributionc@cdc.gov](mailto:vaccinedistributionc@cdc.gov)_ email box **for the state-funded bulk order** Excel spreadsheet and forms or package inserts needing CDC approval
- Please use _[cdccustomerservice@mckesson.com](mailto:cdccustomerservice@mckesson.com)_ or the toll free phone number (877) 822-7746 for any **customer care issues**
- McKesson will not ship the following days this holiday season:  **November 21-23 (Wed - Fri) and December 24-25 (Mon - Tue), 2007 **
- Please follow existing and new procedures to facilitate more timely and accurate delivery of vaccine shipments.  This applies to:
- State funded orders
- Priority orders
- Cancelled orders
- Box returns

## Other upcoming items include...

- Setting a threshold for reorder for non-federal contract vaccines
- Scheduling grantee tour of the McKesson Specialty distribution center in Memphis and customer service center in Lewisville (if requested)
- Revising and distributing the Project Points of Contact (PPOC) document
- Scheduling pre- and post-transition site visits from CDC as needed
- Rolling out additional grantee-specific CQI initiatives as needed
- Planning the opening of Sacramento distribution center (expected to begin operation in early 2008)

## Q and A

## Program Managers Meeting
Atlanta, GA
November 8, 2007

**Atlanta, GA**
**November 8, 2007**

**Vaccine Management Business Improvement Project****(VMBIP)****Systems Overview**

## Today’s Agenda

- VODS1 Update
- Plan for Reengaging Grantees
- Q & A

*1 **The end-state name for the web-based vaccine ordering tool is under discussion*

## Doug Correll assumed CDC IT lead role for VODS in September
VODS Phase 1 design tasks were solidified in August & September
The primary deliverables for Phase 1 of the contract are as follows:
Gap Analysis: Provide analysis on options and recommendations to address “gaps” between SAP functionality and VMBIP business requirements 
Prototype: Demonstrate initial prototype, following two key scenarios, that sufficiently showcases VODS end-state solution to Program and key Stakeholders so that final sign-off on design is secured 
Blue Print: Deliver Accelerated SAP (ASAP) blueprint document that includes solution mapping for all Ordering & Distribution and Grantee Monitoring requirements
VMBIP contract also provides resources to support program/project management, stakeholder management, and solution management during VODS design, testing, piloting, and implementation phases

- VODS Phase 1 design tasks were solidified in August & September
- The primary deliverables for Phase 1 of the contract are as follows:
**Gap Analysis: **Provide analysis on options and recommendations to address “gaps” between SAP functionality and VMBIP business requirements
**Prototype: **Demonstrate initial prototype, following two key scenarios, that sufficiently showcases VODS end-state solution to Program and key Stakeholders so that final sign-off on design is secured
**Blue Print: **Deliver Accelerated SAP (ASAP) blueprint document that includes solution mapping for all Ordering & Distribution and Grantee Monitoring requirements
- VMBIP contract also provides resources to support program/project management, stakeholder management, and solution management during VODS design, testing, piloting, and implementation phases

**VODS project has kicked off with a clear view of the architecture and scope**

## VODS also has a timeline and set of milestones that culminate in a Blueprint in December 2007

## The future plans will be solidified by 1st Quarter, 2008 

- Complete VODS phase 1 by December, 2007
- Prototype
- Fit Gap Analysis
- Blueprint
- Continue with Pan Flu Support
- Solidify plans for moving forward with phase 2
- Guiding principles
- Reengage the Grantee community
- Use standard Accelerated SAP (ASAP) methodology
- Targeted toward “out-of-the-box” SAP implementation

*So how do we plan to reengage the Grantee community...*

## Today’s Agenda

- VODS Update
- Plan for Reengaging Grantees
- Q & A

## Our plan for reengaging the Grantee community includes the following...

- VODS Prototyping sessions to be held beginning in late November
- Grantee Advisory Team to be stood up
- Messaging Workgroup to be stood up
- Quarterly communications to be provided by CDC

## Questions?

## Appendix

## VACMAN 4.x will continue to be used as a tool to enable Centralized Distribution implementation

- Modifying VACMAN to accommodate Centralized Distribution will continue to occur;  however, no major enhancements to be provided
- VACMAN 4.3 released in October
- During last update, it was stated that Grantees and Providers could expect the following:
- Grantees place provider vaccine orders on behalf of the provider and also Grantee-funded bulk vaccine orders  ***Has been occurring***
- Order receipt data will be sent from Distributor to NIPVAC and accessed via VACMAN Provider receipt screen   ***Has been occurring***
- Spend Plan Monitoring Reports will be generated from the Data Warehouse and are available via request from your POB Project Officer  Being providing through other means due to technical difficulties.  ***This will continue until reports are available. ***
- CDC Project Officers will have access to the data warehouse and can generate the following reports:  Are working with McKesson and other means to meet reporting needs due to technical difficulties. ***This will continue until reports are available.***
- Shipment Status, Backorder, Adjustments, Inventory Transaction, Calculated Inventory, Grantee-Specific Inventory, Distribution Summary by Grantee, Nonviable Vaccine, Stockpile/Short-Dated Vaccine