The U.S. healthcare supply chain has been caught off-guard by the impact of the novel coronavirus. Shortages have ranged from personal protective equipment (PPE) to pharmaceuticals to ICU beds in some cities.

For instance, large healthcare supply distributors warned customers about historic back-order rates and low inventory. Several reportedly turned to allocation, or partial fulfillment, of orders for COVID-19-related drugs. Yet some states dismantled unused temporary tent hospitals erected to handle overflow, while others shipped their unneeded ventilators to harder-hit locations or back to the national stockpile. Meanwhile, supplies required to test for COVID-19 remain in short supply.

The general inability to successfully forecast and meet demand for supplies during the pandemic has been painfully apparent. Clearly, healthcare systems, government agencies and large supply distributors must create a more responsive and resilient healthcare supply chain if countries are to contend effectively with future pandemics.

Some change will likely be forced on the industry, as major suppliers in India and China restrict exports of key ingredients and products to meet their own needs. Federal legislators also are investigating the impact of relying on imported medical supplies.

Instead of waiting for rules and regulations, the healthcare industry can over the next few years take advantage of the business and cultural changes accelerated by COVID-19 to rethink what medical supplies are and how to manage them. Increased automation in manufacturing and logistics and more at-home and virtual care are creating new options for building more distributed, resilient healthcare supply chain networks.

May the Chain Be Unbroken

Artificial intelligence (AI)-based technologies and healthcare data interoperability will align to enable timely, accurate supply forecasts to fill networks with the right goods at the right time. To accomplish these goals, and structure a more digitized, resilient healthcare supply chain, the industry must make these shifts:

  • Take a global approach to inventory management. The industry can create more intelligent and agile healthcare supply chain networks to distribute critical items where they’re most needed in a pandemic. Health data interoperability will act as an early-warning system. Public health data and epidemiological analysis can be integrated with predictive and prescriptive supply chain management modeling, alerts and assessments so manufacturers and distributors know to ramp up operations. Large distributors and health systems could deploy supply chain resilience platforms for active risk tracking.

    Given the fact that even local healthcare providers operate in an international economy, it will be important to have a global view about the impact of a pandemic on key supplies and pharmaceuticals. The industry could create a shared utility, akin to the financial industry’s Depository Trust & Clearing organization, for monitoring and to determine the best use of the supply chain. Analytics and modeling tools could help coordinate when and where raw materials and finished goods must be sent. An objective third-party agency, such as the World Health Organization, could act in concert with national public health bodies to provide oversight. 

  • Create a sourcing strategy to mitigate supply chain risk vs. optimizing for lowest cost. Most healthcare organizations source supplies as cheaply as possible to keep costs in check: Supplies account for as much as 40% of a healthcare system’s expenses. Going forward, hospitals will calculate new equations that balance increased expense with the need for better risk management and operating flexibility.

    The large distributors on which most health providers rely – such as Cardinal Health, McKesson AmerisourceBergen and Johnson & Johnson – will likely source more goods from wider networks and more onshore manufacturers. Pharma companies will likely use multiple contract manufacturers around the world to produce the same product and source ingredients from multiple pre-approved suppliers. 

  • Adopt more resilient manufacturing and logistics practices. By using AI, remote monitoring and robotics, manufacturing facilities and warehouses will need fewer human workers and can continue operating efficiently even during pandemics.

    Sanofi’s biologics manufacturing facility in Framingham, Mass., uses collaborative robots, predictive analytics and augmented reality solutions to augment human workers and maintain continuous output. Sensors can help protect employees and keep facilities operating by monitoring body temperatures, ensuring social distance guidelines are followed, sampling and improving air quality as needed, and even ensuring proper handwashing.

  • Encourage innovation in equipment production and design. As N95 mask shortages became apparent, large and small “makers” around the world quickly designed and produced a variety of protective devices. Hospitals rigged ventilators to support multiple patients; at least one facility used a 3-D printer to create adaptors that converted bi-level positive airway pressure (BiPAP) devices into ventilators. Similar ingenuity can be applied to other medical supplies and devices. Expect to see more modular equipment designs that might serve multiple purposes depending on how the components are assembled. This capability provides more flexibility during high-demand periods and conceivably could be more cost-effective.
  • Recognize new endpoints on supply chain. Availability of and access to care is a critical supply measure hard-hit by COVID-19. Since approximately mid-March, IQVIA reports in-person visits to physician offices are down 70% to 80%, and 25% of patient consults have been conducted via telemedicine. Visits by asymptomatic patients are down 76%, and claims for mammograms, colonoscopies and pap smears fell 87%, 90% and 83% respectively from the end of February through mid-April. Those missed screenings could translate into as many as 80,000 fewer cancer diagnoses.

    Going forward, the industry will deal with these access issues through increasingly affordable diagnostic and monitoring tools that will be integrated into health consumers’ lives. These devices will detect health issues via samples of breath, hair, skin, urine and blood. Digital therapeutics will use data from these devices to provide personalized and contextualized in-home care experiences, creating a new model of continuous care.

    Super-clinics, ambulatory care centers and specialty pharmacy centers will augment this in-home care when the industry factors these endpoints into its care supply chain. Instead of being empty, these care centers will become first-line community-based options for accessing care in the next pandemic – especially for well- and preventative-care, as well as screenings. This will help ensure a future pandemic does not create additional health issues through missed care.

The industry will have opportunities to test these shifts as COVID-19 vaccines begin to be manufactured and distributed into 2021 and beyond. By applying the hard lessons taught by the pandemic about the need to forecast demand, inject resiliency and creativity into manufacturing and design, and expand thinking about access to care, the industry will be fully on-guard for the next pandemic.

Pari Sanghavi, Senior Director, Life Sciences Supply Chain & Manufacturing at Cognizant, contributed to this blog.
 

This blog is part of our special report on the future of infectious disease. Stay tuned for more blogs on this topic.

Visit our COVID-19 resources page for additional insights and updates

 
 
Patricia Birch

Patricia Birch

Patricia (Trish) Birch is Senior Vice-President & Global Practice Leader, Healthcare Consulting, at Cognizant. In this role, she leads Cognizant’s Healthcare Consulting Practice,... Read more

Peter Borden

Peter Borden

Peter Borden is Chief Digital Officer for Healthcare at Cognizant, responsible for strategy, innovation, strategic partnerships and special programs across Cognizant’s healthcare... Read more

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