If your site is sustained as a 330/FQHC, this may be good news and provide a path forward for you to expand your commitment to pharmaceutical access.

Free Clinics and FQHCs present two different sustainability models, but they often serve similar patient populations. (In fact, many FQHCs used to be free, faith-based, or community clinics.) If you walked into each of their waiting rooms, you’d be hard pressed to see a difference. You would see a difference in what and how patients are charged. Free Clinics typically provide services at no or low cost. They are defined as “volunteer-based, safety-net health care organizations that provide a range of medical, dental, pharmacy, and/or behavioral health services to economically disadvantaged individuals who are predominately uninsured. Free clinics are 501(c)(3) tax-exempt organizations, or operate as a program component or affiliate of a 501(c)(3) organization. Entities that otherwise meet the above definition, but charge a nominal fee to patients, may still be considered free clinics provided essential services are delivered regardless of the patient’s ability to pay.” FQHCs have a sliding scale so patients contribute based on their income and what they can afford.  Free Clinics cover their operating costs through donations (staff who donate their time, hospitals who donate in-kind equipment and services, and foundations and individuals who donate money).  FQHCs bill for care provided to insured patients to generate enough revenue to cross-subsidize uninsured patients and cover operating costs.

The advent of health reform and the projected decrease in the uninsured population is accelerating the need for free clinics to decide what part they want to play and how they’ll stay sustainable. They have to consider if their mission is defined by the people they serve or the funding model of “free”. They have to decide whether they are most committed to the patients they currently serve (and are willing to evolve their models to take care of them if they become insured), or they are most committed to strictly uninsured patients (even if they are fewer in number or concentrated in fewer states where immigrants reside).  The conference set up the discussion, facilitated the competing arguments, and challenged everyone to take action.  Avoiding the future won’t stop it from coming. I’m optimistic to see how free clinics respond to the opportunities at hand.

• They’re startled by the fact that there are more then 1.3 million nonprofits in the US, and despite the fact that annual giving grew by 255% between 1980 and 2005, the United States dropped from 2^nd to 12^th in basic measures of health, education, and economic opportunity.  Certainly, we are better off due to their collective efforts, but are we investing in the right objectives if our outcomes are slipping?

• They’re curious by the fact that only 1% of nonprofits have budgets greater then $10 million while 90% of nonprofits are small with budgets less then $500,000. Are many of these nonprofits duplicating efforts and/or too small to create significant change?

• They’re aware that most nonprofits function alone and that “collaboration throughout the sector is almost impossible, as each nonprofit competes for funding by trying to persuade donors that its approach is better then any other organization addressing the same issues. Very few systematically track their own impact.” They are right to ask if the well-intended, but disjointed efforts of countless struggling nonprofits will lead to workable solutions for large-scale social problems.

Writing for the Stanford Social Innovation Review, Mark R. Kramer framed these concerns and outlined 4 practices of catalytic philanthropy for donors who want to buck the status quo and make significant change:

1. Take Responsibility for Achieving Results: If a donor wants to solve a problem, they must decide to do so   themselves by getting personally involved and not just investing dollars.
2. Mobilize a Campaign for Change: Adaptive challenges require cross-sector collaborations and mobilizing stakeholders.
3. Use All Available Tools: Tap into corporate resources, investment capital, advocacy and litigation, lobbying.
4. Create Actionable Knowledge: Compile and analyze the data to inform refined change strategies

 If you would like to learn more about the Dispensary of Hope, its programs, and how you can help, please visit www.dispensaryofhope.org.

I wish this technology existed when I worked at Wal-Mart as a cashier! As an Inventory Manager, I would be concerned with the accuracy of the tags and scanners.

Do you think there will be more or less errors when this new technology is implemented?  Will the “Customer Service” area receive more complaints?  Will theft be easier or harder to monitor?  Let me know your reaction.

 So, I’d like to know – What have YOU been seeing in regards to pharma reps and samples in your office?  Have they decreased? Not changed?  Are you no longer seeing pharmaceutical representatives by choice?  Leave a comment and let us know!

At the Dispensary of Hope, we have developed a rubrick to help us make short-term decisions that align with our long-term priorities. Still, it takes discipline to follow it. When funding is involved, in the non-profit space, it is tempting to chase dollars and let temporary funding drive program expansion. This may be a necessity to balance a budget periodically, but long-term resilientcy requires discipline and focus.  The leader of a prominent family foundation recently reminded our leadership team that, “we are defined as much by what we say no to as what we say yes to”.

Reliable brands hold themselves accountable for their claims and performance, often applying new models of assurance. Traditionally, brands have done this with certifications or other independently audited standards. But we think the brand itself is becoming the ‘certification’, and that, in future, confidence will come less from 3rd party validation and more from transparency. Timberland’s Voices of Challenge series seeks credibility through transparent dialogue. Thought leaders, experts, and corporate practitioners lead the online discussion of key sustainability challenges and, in the process, impart their own credibility onto Timberland’s related efforts.Unilever’s brand family is similarly reaping the benefits of its efforts to lead groups like the Roundtable on Sustainable Palm Oil and the Marine Stewardship Council. 

At the Dispensary of Hope, the reliability of our processes is validated by Board of Pharmacy certifications, CHAN audits, and Pharmaceutical Manufacturer audits.  We meet weekly to discuss dozens of internal metrics that reveal throughput, perfect order index, and feedback from our network of sites. Our Instant Access Program has intrinsic constrains around availability of donated medications, but we work hard to improve the availability of the 700+ medications, and we make sure that the aspects we can control (ordering, filling, shipping) are reliable.  Our Continued Access Program’s 700 drugs are highly available but we’ve had to work to make the process reliable and easy to use.  As with other new programs, we launched it with an initial focus group of 10 dispensing sits that provided weekly feedback to make the process more seamless – and ultimately reliable.

• Do you survey your customers?  
• Do you do anything with the feedback?
• How do customers share good news, bad news, or suggestions?
• Did you ever consider that your customers may offer important clues to some of the greatest challenges you’ve been trying to figure out?      

Responsive brands see stakeholders as sources of market insight and intelligence, continually engaging them as collaborators. Responsiveness is the prevailing theme within Microsoft’s advertising campaign for Windows 7, in which supposed customers proclaim “I’m a PC and Windows 7 was my idea.” The same theme underlies Pepsi’s Refresh Project. Rather than spending millions on Super Bowl advertisements (as Pepsi did for the previous 23 years), in 2010 the beverage company invited stakeholders to submit innovative ideas to “refresh” their communities and the world via a branded social media platform. Many of the winning ideas are relevant to Pepsi’s core business and material issues (i.e., consumer health and environmental impacts). 

At the Dispensary of Hope, we try to listen well and be responsive to our customers.  The very genesis of our model was in a response to a need – not an idea. Most every additional feature and new program has also come from what dispensing sites have asked for.  While we’re primarily a solution provider (with 4 programs), we’ve realized how much value there is when we interact as a network, therefore, we’re learning to communicate regularly with the sites and facilitate communication between them.  We added an annual conference to share ideas and ask for feedback.  We survey our customers. We facilitate quarterly conference calls to as for more feedback, and then provide educational webinars where we can respond to the common requests.  We may not be able to help solve every problem or meet every need, but we know that being responsive is a key to our shared sustainability.  Think about if you value leadership’s opinion or the customer’s opinion more? Consider a key questions to ask your customers?

As I continued on my way, I thought about this scenario in my life.  The moment I take my eyes off “my Goal” or my destination and begin to look around to see what others are doing, I get distracted, (which for me is not very hard!)  When I am the most productive, I am constantly looking to “my Goal” and pouring every ounce of energy into it. 

Focus, for me, is something that does not come easy.  Everyday, I struggle to keep my eyes on the “road” to achieve my goal, instead of gazing at the “cars in front of me” that can become distractions.

• Pfizer – 101 million samples worth $2.7 billion
• Merck – 39 million samples worth $356 million
• Eli Lilly – 33 million samples worth $67 million
• Wyeth (since acquired by Pfizer) – 52 million samples worth $64 million
• Abbott Laboratories – 16 million samples worth $32 million
• Baxter International – 33,000 samples worth $7 million
• GRAND TOTAL: 241 million samples worth over $3.2 billion

Although nothing was reported on what drugs were actually sampled, WSJ reports that Pfizer is still marketing top blockbuster drugs like Lipitor and Celebrex. 

This information regarding sampling practices comes as many health care providers across the United States are changing their stance on accepting sample medications.  Some are scaling back on the amount of reps they see to prevent “potential conflicts and safety concerns” while others are continuing to accept samples in order to “save patients money and to test drugs before issuing a full prescription.”  

Since the Dispensary of Hope’s inception, millions of dollars of sample medications have been donated and distributed to patients in need.  To learn more about how sample medications help, visit www.dispensaryofhope.org/give-meds.

Relevant brands address the most material sustainability issues throughout the value chain, whether in the supply, production or use phase. Consider Nespresso’s (a Nestlé brand) Ecolaboration program, for example, which focuses strictly on the coffee company’s three most material impacts – its coffee, capsules, and machines – and touches on various stages of the value chain. Or eBay Green, which sells only used, sustainably sourced or energy efficient products and asks consumers to change traditional thinking on green consumption by saying, “The greenest product is the one that already exists.”  At the Dispensary of Hope, we started by unearthing the potential of billions of dollars of surplus medications across the pharmaceutical supply chain and built a distribution model to provide centralized ordering so dispensing sites can access those medications for patients in need – and think of all the waste avoided.    

At the Dispensary of Hope, two of the things we have learned is that we need to be a “learning organization” and that is that it’s not only what we do, but also how we do it that defines our brand and reveals our commitment to sustainability. As you look at your organization, consider again why you were founded, and if the need is the same or requires you to adapt.  Have the economic challenges of the past few years revealed new ways to operate more efficiently, diversity your funding, and focus on core competencies? Will healthcare reform provide additional opportunities for you to meet your customer’s needs in new ways that are outside your current approach? Do you have the right people on your team to meet the needs of today and the future? These are some of the questions that we reflect on regularly to ensure we remain relevant.

1. Systematic (not piecemeal and divided into silos)
2. Participative (involving many people’s ideas, energy, talent, and expertise – shifting from a “power-over” to a “power-with” approach),
3. Emergent (able to move and adapt nimbly in a minefield of uncertainty).   

 Not-for-profit and philanthropic leaders are often defined by mission and love, while the for-profit sector is often characterized by power and profit. Yet, these binary portraits are too simplistic.  Martin Luther King, Jr. said, “…power without love is reckless and abusive, and love without power is sentimental and anemic.”  Do you think the not-for-profit sector needs to adopt business acumen to survive? Does the for-profit sector need to adopt motivations beyond the bottom line? Would both sectors do well to work together, pool resources, and exercise both power and love?

Last weekend I took a long walk on our beautiful neighborhood greenway with my wife and three kids. Starting from our home, we walked passed my son’s school, the grounds for the new community center, and our public library. It was sunny and 70 degrees and I was feeling grateful… and then I realized that this was, as they say, my tax dollars at work. Look around: there are lots of road improvement projects and community health centers popping up, but still, most of our personal budgets are tight and tax day does not typically fill us with warm feelings.  So, I started thinking differently about how much I contribute to live in my chosen neighborhood (via property taxes) and in my state and in our country (via income, sales, and other taxes) and how happy (or not) I am with the return on that investment. To create the kind of neighborhood and country I want to live in requires some initiatives that I could never accomplish on my own; but if everyone contributes, we can. Still, more then 50% of low wage American’s don’t pay income taxes at all – but they still gain the benefits – so those who pay taxes, subsidize those who don’t. On the other side of the spectrum, investor Warren Buffett suggests the wealthy don’t pay enough stating it’s a “bad system” that multibillionaires such as him pay a lower percentage of income in payroll taxes than their receptionists.  

But are we satisfied with what we’re paying for? What if taxes are the dues that we as Americans pay to ensure the common good? What if they create the kind of country that I want to live in? My neighborhood greenway experience made me feel better about my local taxes, so I decided to do a little more research to see how I felt about taxes and spending on a national level. Here’s a partial snapshot of the total 2009 budget priorities:

$10B on parks

$22B to ensure justice

$38B for diplomacy around the world

$44B to support our veterans

$59B for education

$63B for planes, trains, and automobiles

$68B for healthcare and research

$644B for social security for our seniors

$624B for healthcare for our seniors and the poor

$799B for our military and global war on terror

Some say that the budget is a moral document reflecting who we are as a people. Does this reflect your priorities and values? When you take into consideration that we also spend $260B in interest to borrow money to pay for these priorities, plus run an additional $407B deficit, is our current method of contributions (taxes) and investments (spending) sustainable?

On March 14^th, the employees of an Eli Lilly warehouse arrived at work to find over $75 million of medication missing.  Through an elaborate scheme straight out of the movies, thieves were able to leave the warehouse without being detected.  Click here to read the entire story.  

On a much smaller scale, I have felt the pain the Eli Lilly employees must have felt.  The feelings of being violated and betrayal are endless.  Throughout my career I have wondered why someone feels the need to work so hard to steal from someone else.  Why can’t this energy be focused into something productive?

We all know the saying, “if it doesn’t get measured, it doesn’t get done”, so what should we be measuring to cut costs?

In health care, as in other businesses, the big picture goal involves producing products or services at an efficient level of cost. For healthcare, the product is a specific encounter of care, an inpatient discharge, or an outpatient visit.  With the many variables within diagnosis, treatment, and reimbursement measuring “variable cost” is important.  So if we’re not going to raise taxes or cut benefits, where will costs savings come from?   

•  Alternative “Evidence Based” Treatment Protocols: By lowering the intensity of services for a defined encounter of care we can reduce the total cost per encounter.
• Less expensive supplies/products: By lowering the unit costs of departmental products that together constitute a patient encounter, we can reduce the total cost of the encounter.
• Right size staffing: By analyzing staffing and salaries plus the price paid to hire, train and retain staff, we can reduce long-term costs.
• Aligning the Relationship of all 3: By staying focused on the cost per encounter, we maintain a holistic view. As we consider treatment, salaries, staffing, and use of ancillaries, we can avoid rash cuts in any one area that may ultimately not achieve our ultimate goal of lower per patient encounters. There are trade-offs that can and do exist among all three areas.

I doubt that the industry will rest on the positives of 30 million new “paying” customers; rather, they are hard at work to figure out ways to amend the law and their own practices to achieve long-term sustainability.

During this year’s Network Conference, we took a huge leap forward announcing the expansion of the Continued Access Program.  For those medications we cannot fill through our mail-order pharmacy (we currently fill for 60 medications), the Dispensary of Hope is coordinating the enrollment, refills, and re-enrollment for patients into ALL manufacturers’ prescription assistance programs—providing additional access to 3000+ medications. 

During “Innovating PAP for Continued Access”, participants learned how their dispensing sites can take further advantage of the Dispensary of Hope’s Continued Access Program and will be among the first dispensing sites to gain access to this program across the country.

• Remember that “good people make gifts for two major reasons: to change lives or save lives”
• Leverage local radio personalities to generate interest and funds (i.e. Rick and Bubba show fundraiser for Birmingham, AL sites)
• Learn the language ROI (Return on Investment)
• Pitch an investment opportunity versus a donation request
• Highlight the Lichtenburg study to engage local hospitals to invest in your dispensing sites
• Simplify your story, supported by a few key outcomes and patient stories to submit an effective grant
• Understand how has the funding community changed in the past 10 years to require more metrics and evidence of long-term sustainability
• Plan for how funding community will change in the next 10 years to require more collaboration to gain funding
• Leverage challenge grants to improve fundraising scope and participation   
• Incorporate “tried and true” approaches like dinners, raffles, sponsor a patient, sponsor a day, duck race
• Shift to funder-centric fundraising – Don’t try to sell them on what you do; align yourself with what they care about
• Nurture relationships with our funders. Don’t neglect them.
• Thank donors and prospects 3-4 times annually
• Practice the “3 B’s”: Be present, Be happy, Be brief

Tim Lance discussed the Dispensary of Hope’s secure process of shipping and receiving medications as well as the physical storage requirements required by the FDA.  Rachel Coleman was able to explain the Prescription Drug Marketing Act and how it applied to Free Clinics.  Bruce Haukohl gave a description of the Dispensary of Hope’s secure software application, e-Hope, and its ability to protect patient’s personal health information. 

Thank you to the panelists and the attendees for making the Conference such a great time of interaction and learning.

To speak to these challenges, we assembled a panel that included David Neu and Patricia Baron, pharmacy managers from two dispensing sites in Nashville and in Binghamtom, New York.  Additionally, we were joined by Kate Payne, Ethics Director at St. Thomas Hospital to speak to the ethical considerations relevant to formulary building.

In “Architecture of an Effective Formulary”, panelists gave insight into how to build a formulary around the following considerations: 

• Patients’ continuum of care
• Prescriber preferences and influences
• Patient preferences and influence
• Ethics—such as veracity, autonomy, informed consent, beneficence, fidelity, and distributive justice
• Affordability and adherence
• Brand vs. generic
• Dispensing site size, type, and payer mix

 In “Turning Rx Excess into Rx Access,” we:

• Discussed different ways to engage our local medical communities to support our clinics/pharmacies by donating sample medication to the Dispensary of Hope,
• Were provided with a comprehensive toolkit explaining step by step how to reach out to the local medical community,
• Talked about the Dispensary of Hope’s ‘Essential Drug List’ and how the DOH works with health care providers and manufacturers to obtain these medications.

 A big thank you and shout out to our lovely panelists, Beth Trumbull of the Dispensary of Hope at Knox County Health Department, Sue Spink from Lourdes Hospital and Heidi Buschmann of Dispensary of Hope, for providing their insight on the subject.

 In “Sustainability through Storytelling” we were coached how to:

• Refine our stories so they are concise, current, and change-oriented
• Provide a more astute articulation of the economic impact and ROI for business audiences
• Build relationships with media and political contacts long before we need them
• Ask what kind of stories they are looking to ensure long-term symbiotic partnerships
• Host tours and media events at our site locations
• Launch Effective Press Releases

Last week, I was approached by someone in need of medication for a mission trip in Ecuador.  Unfortunately, we did not have the medication.  However, I have built a relationship with an organization, Kingsway Charities, which is able to send medication overseas.  I was able to direct the person to them and from what I understand; a number of babies in Ecuador will be receiving medication to relieve the symptoms of cradle cap. 

I believe it is just as enjoyable to help provide a solution as it is to actually be the provider for the solution.  Working in a distribution center, we don’t always get to see the faces or hear the stories of the people we are helping.  I thoroughly enjoyed reading the email from the person whom Kingsway Charities provided the medication and look forward to hearing how the medication was able to be used.

An article in the New York Times earlier this month details the recent phenomenon of new medical schools.  In the 1980s and 1990s, only one new medical school was opened.  Today, there are close to 24 new schools that have opened or are preparing to open in the next few years.  Many of these schools are placing a strong focus on primary care for the indigent in urban and rural areas in hopes to persuade more students to become primary care docs.  However, some people think that there will continue to be a provider shortage as these students graduate and congregate in wealthier communities across the U.S. rather than the areas with the most need.  It will definitely be interesting to see how this pans out over the next 5 to 10 years.

We could all benefit from the pleasant surprise of our largest institution, the federal government, working together and for us – instead of positioning for carefully crafted sound bites designed to score points with their bases and to be used in campaign commercials leading up to November’s elections. Additionally, this is a unique chance to be an American, to participate in civics, and to share in the discussion about how to make a “more perfect union”.  Less we shrug it off, cynical or comfortable (because we are lucky enough to be employed and insured), this is an opportunity to reconsider the ethics and economics of healthcare –as Thursday’s discussion is not just about policy, it’s about people. It’s about the nearly 50 million uninsured in crisis and another 27 million who buy their own “individual” coverage directly from an insurer (or have tried to and can’t afford it or were cut). We could be among them soon – so it may be worth paying attention.

So, as you consider what to watch (or DVR, if you’re like me and will be at work), consider skipping Oprah and Ellen and tune in to the health reform discussion.

First, I repeat the information in the exact same manner as my first instruction.  If this doesn’t work, I repeat the same information, but louder.  If they still do not understand, I write down the same information that I just yelled in their ear.  If they still do not get it, I find an easier job for them.  While some of my employees may see some of these qualities as part of my management style, I do not intentionally model any of these behaviors. 

In all seriousness, I feel the most important part of teaching is the ability to identify the way someone learns.  Too many times, I have told an employee a precise way to accomplish a task and they would do it completely wrong.  When I would follow up and demonstrate the activity, I would hear, “Oh! Now, I get it?”

As a leader, it can sometimes be easier to “find someone an easier job” than to teach them the right way to do the harder job.  However, it is much more rewarding for the employee and the employer when the employee achieves success.

 Check out the full story here.

I don’t think anyone could have imagined that Toyota would be facing all of this scrutiny over a gas pedal.  So far a gas pedal is blamed for 19 deaths, Toyota losing $500 million a week, the manufacturer of the gas pedal losing a multi million dollar contract, production and sales halted for at least eight models, and numerous layoffs of employees, just to name a few. 

I can not speculate the long term affects of the recall for Toyota, but I do know of a number of lives and decisions that have been affected due to the recall of a seemingly small defective part.  How have you been impacted by this recall or any other recall?

“Bring an object from your work space that is very important and represents your work at the Dispensary of Hope.  This could be a simple object that you use everyday, such as a stapler or particular form, or maybe it’s a coffee mug or can of Diet coke.  This object is an integral part of your work and perhaps it’s something you take for granted, but without it your job performance would suffer and thus the mission of the Dispensary of Hope would suffer.”

When we came together to discuss our items (during what we call ‘Circle Time’), we had all brought things such as notebooks, calendars/planners, contact lists, and the like.  None of us could imagine working without these items on a daily basis.

A week and a half later, I found an article on CNN.com about American physicians in Haiti working to save lives with the limited resources they have.  The featured physicians come from a top-notch hospital in Boston and have the latest technology at their fingertips for every procedure they perform.  As they now work to save the lives of those hurt in the earthquake, they are forced to improvise and use their basic knowledge medicine without fancy equipment, readily available medicine, and extra help from nurses and staff to care for these patients in need.  The physicians are forced to complete all jobs within the hospital including cleaning and transporting bodies.  Each physician discusses what a humbling experience this has been.

If these physicians had been asked to identify the objects most vital to their day-to-day work before they went to Haiti, I imagine they would have mentioned items that they are currently without as they care for earthquake victims but they have been able to make do with what they have.  If these physicians can save lives without an operating room, lights and medicine, I can surely go without my planner for a week.

• Is justice accomplished by maximizing utility or welfare for the majority- the greatest happiness for the greatest number (the utilitarian view)?
• Is justice accomplished by respecting freedom of individuals and their choices as expressed in the free market or original position of equality (the libertarian and egalitarian views)?
• Is justice accomplished by cultivating virtue and reasoning about the common good?

Whichever philosophical framework appeals to you, we must all confront the fact that freedom and justice, individual interests and the common good, increasing economic output and respecting peoples rights need to work together… and as Sandel suggests, “We need to… create a public culture hospitable to the disagreements that will inevitably arise.”

The first issue, and often overlooked, is identifying and coordinating the items needed for the relief effort.  We are blessed to live in a country where so many people want to help; but sometimes too much help can be a disaster in itself.  When too many of the wrong items are received, destruction costs and time to sort through the items are wasted.

Another issue facing the relief effort is getting the needed items into Haiti.  The airport only has one runway.  I have never been to Haiti, but I have seen small American airports.  These airports are not equipped to handle the air traffic needed to support the relief effort for the approximately 9 million Haitian inhabitants. Even though Haiti does have a port city, many of the piers were damaged during the earthquake making offloading of supplies extremely difficult.

Once the items have entered Haiti, the roads must be cleared to ensure delivery to sites where the relief items can be distributed by able volunteers in an efficient and safe manner. 

Even though there are so many obstacles in relief efforts, I am always amazed at how many people from so many different countries come to the aid of people in need.

 While they boast they receive no NHS or other government funding, the City of London Migraine Clinic asks their patients for a minimum donation of £100 (about $200 USD).  Those patients that are unemployed or low income are asked to only pay what they can. 

An interesting model to check out here.

Just yesterday, The New York Times reported that Stanford University has announced “plans to develop new continuing education programs for doctors that will be devoid of drug industry influence”.  Interestingly enough, Stanford University is doing this with the help of a $3 million grant from none other than the pharmaceutical giant Pfizer.  

According to Stanford’s dean of medicine, Pfizer will have no say in how the new CME programs are planned. The programs will focus on major topics like diabetes, cardiovascular disease, smoking cessation and infections and will be held on the university’s campus rather than at a hotel or resort.  

So, what are your thoughts?  Do you think Stanford will be able to eliminate pharmaceutical influence in CME courses?  

Providers – What are your feelings on how CME is conducted today? Would you attend a session at Stanford when they become available?

So, if you’re watching your favorite NFL team this weekend, and the game could go either way, remember the uphill battle our hospitals are facing. If you’re lucky enough to have your team up by 3 or 6 points, but it’s coming down to the wire, and the other team is driving towards the in zone, you’ll be pulling for your defense. You cannot afford to lose the game so most likely you too will go into prevent defense – because in both arenas, it’s essential to prevent a come back.

For many of us, 2009 was marked by the economic crisis and the increase in demand for time and services amongst our patients and clients. We have been deeply humbled by the work our clinics have performed and the compassion physicians and staff have shown to patients struggling to meet their physical, emotional and spiritual needs. During this time of reflection, we feel most grateful to be surrounded by such giving and generous individuals.

With an increase in demand for services, 2009 also marked a year of tremendous growth for the Dispensary. We effectively grew from 10 dispensing sites to more than 50 sites spanning 12 states. We are currently adding another 4-6 additional sites each month and hope to eclipse 100 sites by the end of 2010. We launched our Continued Access Program in Tennessee in partnership with several national pharmaceutical companies and now have over 1350 participating physicians from across the country donating to our Instant Access Program. Over 100,000 scripts will be provided for through our various programs this year and we’re excited to witness our continued growth in 2010.

Most importantly, we want to take time during this season to say “thank you” to all our supporters. Clinics, physicians, and donors – without you we would have no hope to dispense. We remain deeply grateful for all that you do with us and remain committed to ensuring your support is maximized and extended to those who need us most. Should we ever be able to help in your efforts or better respond to your needs, please don’t hesitate to call or email us directly.

We wish each of you a warm holiday season and a blessed new year! Thank you again for your help and interest in the Dispensary of Hope.

Over the last couple of weeks, I have been trying to maximize the capabilities of our shipping software (UPS Worldship).  I know this is going to sound like a “plug” for UPS, but Worldship has a number of features that make shipping “easy”. 

By making minimal modifications to our internal database, uploading the customer information into Worldship, and creating “Profiles” in Worldship, I have cut our shipping labor in half. 

Not only have the changes affected the cost of labor, it has also helped me to be better prepared for the growth we are expecting in the coming year.

If you are a UPS-Worldship user and would like to discuss, feel free to leave any comments.

Happy Holidays!

In the supply chain, it is extremely inefficient to inspect every order or every item that is manufactured.  If a company tried to double check everything, costs would increase dramatically.  However, there will always be a need to ensure quality control is in place. 

The most important thing is to train the employee correctly and follow up periodically.

Once an individual is trained and proven trustworthy, inspection of the work can be decreased.  Inspection should never be removed entirely, but it can become less frequent and used for praise, as well as coaching. 

The quality of work rests solely on the individuals in which a manager has put trust.  An effective manager must ensure procedures are communicated effectively to the employees and the procedures are followed, while walking a fine line of empowering the employees to perform a job without “the boss” constantly looking over their shoulder.  The confidence a person has in their own abilities will show in the quality of their work and the manager will see results in a higher quality product or service.

NeHC Board member Art Davidson, MD, Director of Public Health Informatics, Denver Health, brings together a panel of experts to discuss the critical importance of data accuracy in electronic health information. Representatives from the healthcare provider, health information exchange, legal and research communities will be on hand to share legal and operational strategies for ensuring and maintaining the accuracy and integrity of health information at the time of capture, exchange and use.

Panelists:

• Jac Davies, MPH, Director of Northwest TeleHealth, Regional Outreach and health@work, Inland Northwest Health Services (INHS)
• W. Holt Anderson, Executive Director, North Carolina Healthcare Information & Communications Alliance, Inc. (NCHICA) 
• Phil Renner, MBA, Assistant Vice President for Quality Measurement, National Committee for Quality Assurance (NCQA) 
• Gerry Hinkley, Esq., Partner and Co-Chair, Health Information Technology & HIPAA Practice, Davis Wright Tremaine LLP

Click here for more information.

 Detailing to Healthcare Providers: $12 billion

Professional Meetings: $3.4 billion

Professional Journal Ads: $0.4 billion

Direct-to-Consumer Ads: $4.7 billion  

The Total?   At least $20.5 billion

The brief also breaks down what classes of drugs are promoted the most.  Unsurprisingly, erectile disfunction tops the list for direct-to-consumer advertising (Is it just me or is anyone else sick of these ads yet?). 

Take a look at the brief for yourself.  It’s no doubt an interesting read.    

 In related news, New Jersey is the newest state to begin cracking down on drug companies’ gift giving and perks for physicians. WSJ Health Blog takes a look at what is being proposed by the NJ Attorney General’s office.

 Happy Holidays!

Delivery day comes around and my friend leaves work at 10:30 to meet the Delivery Team, which will be arriving at his house at 11:00. At 11:15, Billy receives a call from the team stating they will be a little late. He asks them, “How late is a little late?” They say, “A couple of hours.” Billy is a very busy man and can’t wait around “a couple of hours”. He tells the Delivery Team to take the items back to the store; he will find a company that can deliver on time.

In our society, it has become the norm to over promise and under deliver. Billy did everything right. He paid for the items and arrived on time to receive the items.

As a supply chain professional, I see how issues like Billy’s happen. These types of situations can be handled in a way that will make sure both parties are happy. When providing a service, one needs to be able to put themselves in the customer’s shoes. Only promise what can be delivered. With today’s economy, companies can not afford to have revenue slip through the cracks because of an inability to deliver on time, and customers can not afford to be away from work because a delivery team can not deliver on time.

 It turns out that the increase in time my provider spent with me is not an isolated occurrence.  A recent study by the Archives of Internal Medicine found that the amount of time providers spend with their patients increased in the years between 1997 and 2005.  Visit the WSJ Health Blog to learn more about the findings.

• Global Health: Dr Tim Jones, State Epidemiologist highlighted immunizations, TB, emergency preparedness, food borne diseases, hospital infections, zoonotic diseases – concluding how in a global marketplace without borders, we will not be free from disease until the world is free from disease.
• Economic Impact: Gerald Doekson, Phd illustrated how healthcare can be an economic engine in rural communities
• Telehealth: Keith Williams highlighted how Telehealth is connecting 100’s of communities to specialty care, continuing medical education, and improved quality of care for patients.
• State + Dispensary of Hope Solutions: The Dispensary of Hope was part of a panel discussion with David Collier MD from TennCare (Tennessee’s Medicaid entitlement program) and Frank Stevenson with CoverTennessee (Tennessee’s public-private partnership insurance program) – highlighting our new Continued Access Program announced today!  

Early in the training process, employees need guidance to ensure items are located in the proper place. As we continually audit our processes, we have found that simple mistakes are made many times because items have been placed in the incorrect location due to the lack of signage. When items are labeled properly, employees can focus on other important items such as shipping the correct amount to the correct destination. 

In the Distribution Center and at my desk, the more I label the easier my job becomes.  The less I must think the better I will perform.

But let’s not lose sight of the state of our health system. It’s tough times for tech start-ups as they struggle to fill the gaps in an evolving marketplace. It was clear at the conference that many of these companies are struggling for…dare I….”evidence-based technology”—proof that their technology actually works in a real-life setting. In short, what these start-ups are looking for are test sites.

Calling all free clinics!

Free clinics, the often over-looked stepchild of our healthcare safety net, typically the last to bring the latest cutting-edge technology to their staff and patients, struggle without federal funding—relying on grants, personal gifts and the “sliding-scale” patient fee. Did I mention they are free from federal constraints? Alas, an opportunity emerges.

Health 2.0 start-ups need test sites ready, willing and able to trial their latest technology and free clinics need efficiency-driving technology to cut down their costs. While perhaps unexpected and a bit unconventional, a partnership between Health 2.0 and our country’s free clinics could prove extraordinarily beneficial to both.