U.S. Hospitals Study Executive Summary

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1 UPS Healthcare Study Executive September 2017 START 2017 Survey 2017 United Parcel Service of America, Inc. 1

2 An industry facing disruptive change: managing consumerization, clinical outcomes and costs Hospitals are confronting mounting pressures around operating margins and positive patient outcomes. The following trends create ripples through supply chains and necessitate creative solutions to address marketplace disruptions. Hospitals > > An industry facing disruptive change About the survey Regulatory uncertainty Potential regulatory changes from evolving governmental policies create uncertainty about future impacts on hospital operations. Outcome-based reimbursements Hospitals continue to face increased pressure to demonstrate improved patient outcomes, leading to new decision-making processes that weigh both clinical benefits and cost. Patient consumerization Changing demands and increased decisionmaking by consumers are driving the need for a more patient-centered supply chain that supports the delivery of care where and when the patient needs it, which is not always in the hospital. Drug shortages Issues around manufacturers struggles to maintain regulatory compliance, operate resilient supply chains and make strategic decisions to reduce low-margin products have caused systemic drug shortages. Hospitals are diversifying their purchasing beyond usual channels to reduce the risk of future shortages. Continuing consolidation Hospital consolidation continues as more outlying surgical facilities, clinics and ambulatory care centers are merging with larger healthcare systems, driving the need for consistency across more points of care. Technology and innovation Technology is changing clinical workflows and operations, including focusing on virtual care. Plus, the deployment of EHR across extended care networks offers the promise of improved interoperability but comes with short-term challenges that tax IT infrastructure and resources. This section of the is focused on understanding the business priorities, supplier satisfaction and logistics challenges of hospitals in the U.S., while providing valuable insights and implications for their clinical product suppliers, including medical device and pharma manufacturers and distributors. Amidst industry uncertainty, U.S. hospitals are being challenged to increase efficiency while digesting acquisitions and implementing new concepts in care delivery. Margin pressures are driving price sensitivities and efforts to reduce cost throughout the supply chain. Meanwhile, outcome-based reimbursement models mean hospitals must focus on coordinating patient care across a broad spectrum of care-delivery groups while remaining accountable to better outcomes. These factors, combined with the ambiguity surrounding potential regulatory changes, are causing hospitals to re-evaluate their supply chain and logistics strategies Survey 2017 United Parcel Service of America, Inc. 1

3 Who we surveyed This executive summary is focused on U.S. hospitals. Here s a snapshot of the survey respondents and their organizations: Hospital respondents (n=100) Hospitals 45% Private pay An industry facing disruptive change > > About the survey 17% Executives/ VPs/Directors 83% Managers 55% Government pay Hospital type Organization type 38% Standalone 62% Network 38% Profit 62% Non-profit About the survey Since 2008, UPS has surveyed the healthcare and life sciences industry about supply chain issues to better understand marketplace needs. This year we are introducing a new global survey with a new perspective. The 2017 provides the healthcare industry with insights into supply chain issues impacting dispensers, hospitals and laboratories. We surveyed 750 participants from 19 countries across the United States, Europe, Asia-Pacific and Latin America representing executives and managers with purchasing, supply chain or materials management responsibilities across dispensers, hospitals and medical labs. The survey, which provides a 360-degree view of the industry, including manufacturers, distributors and providers, was conducted by PwC on behalf of UPS. This executive summary is focused on survey responses from 100 participants representing U.S.-based hospitals Survey 2017 United Parcel Service of America, Inc. 2

4 > > Prioritizing efficiency and cost control Top priorities for hospitals Q: Over the next 3 years, how important will the following areas be to your hospital/physician network s business results? (% rating very or extremely important) Improving hospital/physician network operating efficiency Controlling supply chain and logistics costs Managing declining payment/prices for clinical services Making capital investments Navigating changes in regulations 69% 66% 63% 78% 82% Industry insight supply chain best practices Leading hospitals implement best practices to improve operating efficiency and manage supply chain cost. Visibility and Collaboration Increased visibility and control of product inventory will help reduce expiry and inventory scrap. Performance Management Tools to efficiently monitor patient outcomes will be critical to assessing performance which will drive reimbursements. Data Standardization and Interconnectivity Standardizing product data across manufacturers, distributors and providers will aid the transition to outcome-driven decisions. Process Standardization Standardized supply chain processes across the care network will help leaders identify cost reduction opportunities. Prioritizing efficiency and cost control Eighty-two percent of hospital provider networks ranked improving operating efficiency as the most crucial priority for achieving their business goals over the next three years. The strong focus on efficiency is driven by multiple factors, with margin pressures and declining reimbursements taking the lead. According to American Hospital Association financial data, the average margin for U.S. hospitals is less than 10% and three out of ten are operating with negative margins. Hospitals have not fully adopted and implemented supply chain best practices found within the industrial, automotive and high-tech industries. Now the trend is changing, supply chain efficiency is being elevated to strategic importance as a means to combat the challenge of declining reimbursements Survey 2017 United Parcel Service of America, Inc. 3

5 53% of hospitals expect additional support from product suppliers Overall Supplier Satisfaction Q: What type of additional support is desired from your clinical product suppliers, healthcare distributors, pharma and medical device manufacturers? Implementation monitoring Maintaining medical device services 13% Product availability Extremely satisfied > > Seeking the right support from clinical suppliers 49% 38% Training Exploring why hospitals switch suppliers Taking advantage of key supplier opportunities guide (us on) how to use equipment and products so that it lasts long and also equipment maintenance support Customer service from product maintenance to post-sales support to new product introductions and 24-hour customer service how to handle or use the product efficiently, maintenance support and taking good care of products so that products do not spoil 33% of hospitals could not say that they are very or extremely satisfied with their primary clinical product supplier Seeking the right support from clinical suppliers Hospitals found customer service lacking among their suppliers, citing it as often unavailable or unresponsive. In fact, customer service was the most requested type of support cited by 49% of hospital survey respondents, followed by training at 38%. Training and clinical support was highly valued by hospitals as 23% reported they would switch suppliers who failed in this area. To clarify, hospitals are seeking support from dedicated trainers or medical professionals with specialist expertise versus sales representatives whose primary job responsibility is to promote new products and services. To improve training efficiency, hospitals and suppliers must be shrewd about using nurse and physician time in this effort. As hospitals are embracing technology to enable a more patient-centric supply chain, it makes sense that respondents are seeking additional support, specifically training on new types of equipment and medical devices being introduced into the marketplace Survey 2017 United Parcel Service of America, Inc. 4

6 Seeking the right support from clinical suppliers > > Exploring why hospitals switch suppliers Taking advantage of key supplier opportunities Why hospitals switch suppliers Q: If your supplier were to fail on any of the following factors, which one or two are most likely to make you switch? 35% Ability to track supplies in transit 50% Product availability 23% Clinical support and training Product availability satisfaction Q: How satisfied or dissatisfied are you with the product availability of your primary clinical product suppliers? 25% Could not say they were very or extremely satisfied Industry insight Optimizing supply management in the operating room Historically, the operating room (OR) supply chain has received less oversight because hospital leadership has been reluctant to challenge surgeon and staff practices. Estimates indicate the OR represents 40-60% of total hospital supply expenditures, but optimizing its supply management has long been a challenge. Poor inventory management, physician preference items, lack of good data, lack of standardization and inefficient practices all contribute to a system that is costly, ineffective and a potential area for savings. Given declining surgical profits and the new economic landscape, healthcare organizations are examining how improving supply management in the OR could improve the bottom line. Exploring why hospitals switch suppliers One in four survey respondents were dissatisfied with product availability from their primary clinical supplier and would be very likely to switch suppliers due to issues in this area. Recent generic injectable drug shortages may be influencing the response to this question. Shortages cost hospitals more than $200M annually, according to The Pew Charitable Trusts. Respondents also identified the ability to track supplies in transit as an area likely to drive a switch in suppliers. Outside of price, product availability and the assurance of timely delivery are the most frequent complaints from hospitals regarding suppliers and are a necessity to ensure positive patient care. If the wrong product is delivered or a critical device needed for surgery arrives late, the procedure will likely be delayed or canceled. Canceled surgeries can have a significant impact on hospitals, which receive most of their revenue from surgical procedures. In addition to potentially affecting a hospital s bottom line, product availability issues will likely erode overall satisfaction and could cost suppliers future business Survey 2017 United Parcel Service of America, Inc. 5

7 Prime opportunities for suppliers Opportunity: High importance/high satisfaction 79% of respondents stated they value help from their clinical suppliers with maintaining regulatory compliance Seeking the right support from clinical suppliers Exploring why hospitals switch suppliers > > Taking advantage of key supplier opportunities Regulatory compliance and/or industry accreditation support Inventory management programs Currently: High importance/low satisfaction Industry insight Suppliers have an opportunity to differentiate themselves from competitors by improving inventory management programs and regulatory compliance support, two key drivers of hospital supplier satisfaction that are not being delivered to satisfaction. Taking advantage of key supplier opportunities Suppliers searching for opportunities to quickly improve customer satisfaction and differentiate themselves should focus efforts on their inventory management programs and regulatory compliance support efforts, if applicable. Both of these areas are strong drivers of hospital satisfaction but are significantly below median satisfaction performance levels. Hospitals want Just-in-Time inventory management and are looking for supplier support as they work to reduce costs and improve their inventory management programs. It s critical to have products in stock to avoid unanticipated delays that impact patient care. This is even more critical for hospitals with the rise of value-based payments. Because hospital storage space is minimal, inventory management can be a competitive differentiator for suppliers. Continued uncertainty surrounding potential changes in federal regulations is impacting U.S. hospitals, with 63% citing navigating regulatory compliance as a business priority over the next three years and 79% saying they value help from their clinical suppliers in maintaining compliance. Therefore, suppliers should maintain or enhance their regulatory compliance, if applicable, to support hospital relationships Survey 2017 United Parcel Service of America, Inc. 6

8 Strategies methods to improve supply chain Q: How important are the following logistical support methods in helping to improve your supply chain? Q: How successful or unsuccessful has your provider network been at implementing the following outbound and home health logistics? > > Collaborating for supply chain improvement 71% Providing standardized product kits and quantities to reduce waste 61% 69% Leveraging advanced data capture and barcodes for inventory 55% 67% Providing manufacturer consigned inventory Capturing and retaining accurate proof of delivery data Tracking, intervening and addressing critical shipment issues while in transit Ensuring specimen pickups at internal labs and clinical sites are completed timely Packing and shipping Biological Substance (UN3373), Category A infectious substances, and radioactive shipments 45% 56% 50% 58% Isolating and identifying STAT shipments for expediting Providing automatic reorder programs based on inventory on hand Collaborating for supply chain improvement Given current market realities, hospitals are considering a broad plan of attack to achieve their goals. Several approaches to improve efficiency rated highly, including inbound freight management, cost controls for physician preference items and alternative forms of distribution. When asked which logistics support methods are the most important for improving the supply chain, providing standardized product kits and quantities to help reduce waste received the highest rating. As an example, a manufacturer of endoscopy devices researched the user experience and successfully created an optimized kit, making it easier for hospitals to pack out and clean up. Hospitals also value how identifying and isolating STAT shipments can expedite receiving, eliminating the need to search through hundreds of items on their receiving dock to find a STAT product needed for surgery. Suppliers must also be aware that hospitals are redistributing products to varied points of care like patient homes, ambulatory surgery centers and urgent care sites. Manufacturers who design and package products with this new reality in mind are likely to gain market share Survey 2017 United Parcel Service of America, Inc. 7

9 The following insights into hospital networks are based on the survey results and include some potential impacts and opportunities for suppliers and manufacturers. Improve efficiency to create value Enhance regulatory compliance support Collaborate to reduce waste Hospitals cited improving operating efficiency as the most crucial business priority for achieving their business goals over the next three years. Declining reimbursements drive a greater importance on this. Suppliers can be part of the solution by increasing transparency into inventory to enable JIT without putting undue risk on patient care, and collaborating to provide standardized product data, which will help facilitate transitioning to outcome-driven decisions. Uncertainty regarding potential regulatory changes are impacting hospital operations. To sustain customer relationships, suppliers should continue to provide programs that help hospitals maintain regulatory compliance, as applicable to the service provided. Based on our research, any reduction in regulatory compliance support would not be well received, as 79% of survey respondents value this type of support and 63% cited navigating regulatory compliance as a top business priority. Survey data suggests that regulatory compliance continues to be highly valued. Hospitals are leveraging supply chain strategies to help reduce waste and streamline operations. Manufacturers and distributors who collaborate with hospitals to better understand the user experience and adjust their products and processes accordingly will be the most likely to succeed. For example, if a manufacturer has been supplying kits containing 5 ml quantities to a hospital that normally uses 3 ml quantities, packing standardized kits with 3 ml quantities would be optimal and help the hospital achieve its goal of reducing waste. Ensure product availability Provide special training & support Enable multiple points of care Other than price, issues with product availability are the main reason hospitals will switch suppliers, followed by the ability to track products in transit. It goes without saying that having products in stock is crucial to hospitals, from both a quality of care and efficiency viewpoint. U.S. hospitals pay at least $200 million more a year than they ordinarily would to find drugs facing shortages. 1 To help solve product availability issues and avoid losing customers, suppliers must have up-to-date visibility of their inventory and should work to improve transparency around communicating potential shortages. Hospitals want additional support from their clinical product suppliers, particularly in customer service and training. By adding programs such as training on new equipment service for asset management, suppliers can help strengthen customer relationships. It s important for suppliers to provide dedicated trainers or medical professionals with specialist product knowledge versus relying on sales representatives whose job responsibility is promoting new products and services. Manufacturers and distributors should recognize that their products are increasingly being distributed by hospitals to varied points of care, such as ambulatory surgery centers, urgent care sites and patients homes. Manufacturers who design and package products with this in mind are likely to gain market share. 1 Analysis finds shortages increased U.S. hospital costs by an average of $230 million annually, February Learn more about the ways UPS can help healthcare companies UPS [INSERT Healthcare NAME] Supply Survey Chain Survey 2017 United Parcel Service of America, Inc. All rights reserved. UPS, the UPS Brandmark and the color brown are trademarks 2017 of United Parcel Service of America, Inc. 8

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