In this interview, Teresa Dail, chief supply chain officer at Vanderbilt University Medical Center (VUMC), shares how organizations can set up an in-house process to provide medical equipment and supplies to both inpatients and patient homes. The following article has been edited for length and clarity.
Could you describe the environment before using internal resources to deliver equipment/supplies directly to patient homes and current state?
In the last couple years, as the chief supply chain officer at VUMC, I was looking at opportunities for supply chain to expand our offerings. During these discussions, value-based reimbursements stood out and we looked at factors that influence reimbursement around patient experience, total cost of care and quality. During this process, we identified gaps/needs that supply chain could address based on interactions with our clinical colleagues. Current state revealed the delivery of home health supplies, durable medical equipment and patient support services, upon discharge from the hospital, were owned by third-party companies. VUMC did not have line of sight into this side of the patient experience and the impact that it might have on patient compliance and our readmission rates.
All of these insights and the intent to close the loop for patients led to the concept of establishing Carefluent Connect (CFC), LLC—a company wholly owned by VUMC focused on durable medical supplies and equipment (DME) and home medical equipment (HME). Under Carefluent Connect, we are developing a program called DME to beds. If patients choose to utilize CFC, we will either deliver the equipment to their hospital room or directly to their home. The organization instituted a meds to beds program a few years ago with our pharmacy team upon patient discharge and the DME to beds program will act as a complement to that. In addition, by the end of our Q1 this year—our fiscal year starts July 1—we plan to open our first 24 virtual beds for hospital to home. The goal is to have 24 virtual beds this year and then add 24 virtual beds each year over the next four years. COVID-19 provided real-time experience for our team to support a “COVID to Home” program where patients of lower acuity could be managed by clinical teams in their home setting. These efforts are helping to provide the framework for a more formal program coming soon.
Will your current logistics partner be used to deliver supplies to patient homes?
Carefluent Connect has purchased vans and trucks, as part of the DME program. We can use the vehicles to deliver medical supplies for hospital to home and home health nursing. The company looked at third-party courier services too, but again, the intent of establishing Carefluent Connect was to take ownership of services that were previously being outsourced. In case of emergencies, we can utilize courier services to deliver products to patient homes, but we don’t want it to be our primary source of delivery. Moreover, when we are servicing DME and HME, it is easy to plan our routes to serve hospital to home or home health patients. We have purchased technology that allows us to plan an efficient delivery route, take accountability for these services and track our drivers and vehicles to ensure timely delivery.
The COVID-19 pandemic accelerated demand for a hospitable home environment and VUMC, under the Emergency Use Authorization, stood up a hospital to home for COVID-19 patients. The supply chain team at VUMC worked with the nurse practitioners that were covering those patients to develop patient care kits. With the support of our logistics team, we supplied the nurse practitioners with products and medical supplies required for patients to take home. Though this was a good temporary measure, with Carefluent Connect having vehicles, staff and a warehouse, we don’t want to burden our logistics and operations team servicing our patients in-house.
What type of DMEPOS (Durable medical equipment, prosthetics, orthotics and Supplies) will be provided by Carefluent to the inpatients?
Carefluent Connect supports inpatients with high-quality DMEPOS products, including blood glucose monitors and/or supplies and diabetic shoes/inserts; ostomy supplies; tracheostomy supplies; wheelchairs—standard manual; canes and crutches; heat and cold applications; urological supplies; commodes/urinals/bedpans; nebulizer equipment; respiratory assist devices; walkers; continuous positive airway pressure (CPAP) devices or supplies; orthoses; surgical dressings; and wheelchair/seating cushions.
What lessons learned or advice would you offer to hospitals and health systems looking to set up HME and DME units?
My advice would be to have a thorough understanding of the state and federal regulatory requirements of the business before establishing it. Understand the key services that you are planning to provide. There are resources that can provide guidance and education on what is needed to achieve accreditation. Since change management is also a huge part of the process, health systems need to effectively communicate the need for the change to all providers.
Once the process has been established, the key step is to collect the patient experience data which measures how well service aspects are in line with customer needs and requirements. From a DME perspective, it is also a revenue stream for the organization. Hospitals need to decide whether they want to give the money to third parties who may not view this as anything more than a transaction and have almost no control over the process, or the health system can have happy patients and doctors while achieving a revenue stream for their organization that is the result of the relationships developed. We established Carefluent Connect in order to be a continuous part of value-based healthcare and take ownership of the entire continuum of care. Even though it’s a for-profit LLC, we are ultimately responsible for providing quality service and products to our patients. We believe this approach will continue to further VUMC’s commitment of “Making Health Care Personal.”
Healthcare operational leaders are not interested in how to “get back to normal.” They are charting a new normal. Leaders are currently looking to:
- Prepare staff for a changing work environment
- Rapidly evolve patient-facing processes in a safe, efficient manner
- Address patient hesitancy proactively
- Rethink revenue management