Slide 1:
Vaccine Management Business Improvement Project 
(VMBIP)
Program Managers Meeting
Atlanta, GA
November 8, 2007

Slide 2:
VMBIP Project Lead

Slide 3:
Today’s Agenda
VMBIP – Lance Rodewald and Brad Prescott
4	Provide a brief overview and update of VMBIP
4	Review issues and resolutions
4	Review the new grantee transition schedule
4	Provide lessons learned and important process changes
4	Give a brief overview of the Continuous Quality Improvement (CQI) analysis

VODS/VaX.NET – Janet Kelly
4	VODS Update 
4	Plan for Reengaging Grantees

McKesson – Terry Fox, Tom Hart, and Jake Frost
4	Updates 
4	Enhancements

Questions

Slide 4:
The Vaccine Management Business Improvement Project (VMBIP) addresses all aspects of public vaccine supply chain

VMBIP Vision

VMBIP Background
•	Started in late 2003 – first ever “top-to-bottom” review of vaccine ordering and distribution
•	Created vision, and working extensively with a huge range of stakeholders to make it happen
•	Project team has worked extensively with CDC representatives and state and local immunization programs – over 70 people (mostly from the grantees) involved in the design process

Distribution
•	Consolidated third party distribution
•	Contract held at Federal level
•	More visibility into vaccine supply

Stockpile
•	Portion of Pediatric Stockpile will be held at centralized distributor

Provider Ordering
•	Web-based provider ordering system (SAP platform)
•	Order approval via automated business rules

CDC Internal Efficiencies
•	Funding obligations now flow through “single VFC and 317 accounts” instead of 64 grantees
•	Improved inventory management will result in enhanced visibility and over $200M in savings
•	Reduced administrative process

At the center of a circle is “CDC Internal Efficiencies”.  This is surrounded by the terms “Distribution”, “Stockpile”, and “Provider Ordering”.

Slide 5:
As of Oct 31, 34 grantees have transitioned to McKesson resulting in over 22.7M doses shipped to providers

All Vaccines Shipment Summary as of October 31
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

Flu Shipment Summary as of November 5
Total doses ordered since start of 2007/2008 flu season: 4,222,016
Total doses shipped since start of the 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

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

Slide 6:
WE ACKNOWLEDGE THAT THERE HAVE BEEN MANY CHALLENGES

Slide 7:
Issues raised on August 22 AIM call (1 of 2)

Chart of issues and their descriptions
Issue:  Vaccine Delivery Times 	
Description: 
1.	McKesson vaccine shipments to providers are averaging two to three weeks. 
2.	AIM members believe the primary reason is due to the five-day shipping language in the contract

Issue:  Order Accuracy	
Description: 
1.	Several projects report a “high” frequency of lost and/or inaccurate orders
2.	Grantees claim that upon receipt of an inaccurate order, the provider was requested to return the viable vaccine to McKesson 

Issue: Order Shipments 	
Description: 
1.	Grantees reporting split shipments, multiple boxes for small orders, and diluents being shipped separate from MMR
2.	Some shipments are arriving without temperature monitor devices or with monitor reading “Not OK”
3.	Grantees do not know, in a timely manner, when vaccine is shipped to providers

Issue: Customer Service	
Description:
1.	Grantees report that McKesson is not returning phone calls within 2-day allotted time period or at all
2.	Grantees reporting inconsistency of information received

Issue: Non-viable Vaccine Returns	
Description:
1.	Many grantees are not clear on the process for returning wasted or expired vaccine

Slide 8: 
Issue: Box Markings and Returns	
Description:
1.	Grantees reporting UPS will not pick up empty boxes to return to McKesson or else will charge a $10 pick-up fee

Issue: Priority Order Limits	
Description:
1.	Are grantees being held t the 2% priority order limit?
2.	What happens if a state goes over its allocation of 2%?
3.	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?

Issue: Influenza Vaccine Shipping	
Description:
1.	How will orders be placed based on availability of National Supply?
2.	How will providers on TOF place orders?
3.	How will availability be communicated?
4.	How will the order be shipped and reported?
5.	What is the process for returning viable vaccine?

Issue: Vaccine Data Information		
Description: 
1.	Not timely distribution of receipt data

Slide 9:
Additional VMBIP CDC Challenges
•	No or Limited data
o	Lack of Data Warehouse
o	Grantee Monitoring and Replenishment Reports delayed or inaccurate
o	No performance data
•	VACMAN/NIPVAC challenges
•	VODS Delay

Slide 10:
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

Slide 11:
With input from McKesson and grantees, we are slowing implementation for the remaining grantees

Grantee Transition Schedule for 2007-2008 with Break in Dec and Jan
Go Live Date: 12-3-07
Grantee: New Mexico
Project Officer: Lewis Anderson
Percentage of Total Annual Doses: 1 percent

Go Live Date: 12-17-07 
Grantee: North Carolina
Project Officer: Mimi Larzelere:
Percentage of Total Annual Doses: 3.90 percent 

Go Live Date: 12-17-07
Grantee: New York
Project Officer: Lewis Anderson
Percentage of Total Annual Doses: 2.10 percent

Mid Dec-Feb CQI Implementation

Go Live Date: 3-3-08
Grantee: Iowa
Project Officer: Mimi Larzelere
Percentage of Total Annual Doses: .06 percent

Go Live Date: 3-3-08
Grantee: San Antonio
Project Officer:  Harry McKnight
Percentage of Total Annual Doses: 0.7 percent

Go Live Date: 3-10-08
Grantee: Mississippi
Project Officer: Harry McKnight
Percentage of Total Annual Doses: 1.0 percent

Go Live Date: 3-10-08
Grantee: Arkansas
Project Officer: Lewis Anderson
Percentage of Total Annual Doses: 1.10 percent

3-17-08 NIC Break

Go Live Date: 3-24-08
Grantee: New Hampshire
Project Officer: Gayle Daniels
Percentage of Total Annual Doses: 0.8 percent

Go Live Date: 3-31-08
Grantee: Louisiana
Project Officer:  Harry McKnight
Percentage of Total Annual Doses: 1.50 percent

Go Live Date: 3-31-08
Grantee: South Dakota
Project Officer: Julie Orta
Percentage of Total Annual Doses: 0.40 percent

Go Live Date: 4-7-08
Grantee: Florida
Project Officer: Mimi Larzelere
Percentage of Total Annual Doses: 4.80 percent
 
Go Live Date: 4-14-08
Grantee: South Carolina
Project Officer:  Harry McKnight
Percentage of Total Annual Doses: 1.50 percent

Go Live Date: 4-10-08
Grantee: Alabama
Project Officer: Gayle Daniels
Percentage of Total Annual Doses: 1.5 percent

Go Live Date:  4-28-08
Grantee: Georgia
Project Officer: Anne Lutz
Percentage of Total Annual Doses: 3.2 percent

Go Live Date: 5-5-08
Grantee: Virgin Islands
Project Officer:  Gabe Anaya
Percentage of Total Annual Doses: 0.0 percent

Go Live Date: 5-5-08
Grantee: Puerto Rico
Project Officer: Gabe Anaya
Percentage of Total Annual Doses: 1.90 percent

Go Live Date: 5-12-08
Grantee: Ohio
Project Officer: Gayle Daniels
Percentage of Total Annual Doses: 3.80 percent

Go Live Date: 5-12-08
Grantee: Michigan
Project Officer: Anne Lutz
Percentage of Total Annual Doses: 2.50 percent

Go Live Date: 5-19-08
Grantee: Illinois
Project Officer:  Harry McKnight
Percentage of Total Annual Doses: 2.40 percent

5-26-08 Memorial Day

Go Live Date: 6-2-08
Grantee:  Wisconsin
Project Officer: Lewis Anderson
Percentage of Total Annual Doses: 1.10 percent

6-9-08 Break

Go Live Date: 6-16-08
Grantee: Vermont
Project Officer: Gayle Daniels
Percentage of Total Annual Doses: .03 percent

Go Live Date:  6-23-08
Grantee: Massachusetts
Project Officer:  Anne Lutz
Percentage of Total Annual Doses: 3.20 percent

Go Live Date: 6-30-08
Grantee: Alaska
Project Officer:  Lewis Anderson 
Percentage of Total Annual Doses: 0.4 percent

Go Live Date: 6-30-08
Grantee: Samoa
Project Officer: Gabe Anaya
Percentage of Total Annual Doses: 0.0 percent

Go Live Date: 6-30-08
Grantee: Micronesia
Project Officer: Gabe Anaya
Percentage of Total Annual Doses: 0.0 percent

Go Live Date: 6-30-08
Grantee:  N Marian Island
Project Officer:  Gabe Anaya
Percentage of Total Annual Doses: 0.0 percent

Go Live Date: 6-30-08
Grantee: Palau
Project Officer:  Gabe Anaya
Percentage of Total Annual Doses: 0.0 percent

Slide 12
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

Slide 13
•	All of the processes are currently working but revealed opportunities for key modifications 
•	The overall process could benefit from:
o	Providers:
o	Standardizing and using best practices for vaccine inventory management
o	Teaching providers how to accurately complete forms and the importance of vaccine inventory management
o	Grantee (CA):
o	A process that balances vaccine accountability processes and expedited order flow
o	Evaluate current order form
o	McKesson:
o	A second picking line (already in progress)
o	Real-time productivity and quality performance feedback to teams
o	Enhanced communications with the customer service team
o	Increased data capture and usage in the customer service process

Slide 14
•	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: 
o	Provider inventory management process development and training 
o	Order form refinement
o	Accountability process development
o	Temperature monitoring trends
o	Assist in evaluation of SharePoint and return data

Slide 15
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

Slide 16
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 email box for the state-funded bulk order Excel spreadsheet and forms or package inserts needing CDC approval 
o	Please use 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:
o	State funded orders
o	Priority orders
o	Cancelled orders
o	Box returns 

Slide 17
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)

Slide 18
Questions and Answers

Slide 19
Vaccine Management Business Improvement Project (VMBIP) Systems Overview
Program Managers Meeting
Atlanta, GA
November 8, 2007

Slide 20
Today’s Agenda
•	VODS (The end-state name for the web-based vaccine ordering tool is under discussion)) Update 
•	Plan for Reengaging Grantees
•	Questions and answers

Slide 21
•	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:
o	Gap Analysis: Provide analysis on options and recommendations to address “gaps” between SAP functionality and VMBIP business requirements 
o	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 
o	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

Slide 22
VODS also has a timeline and set of milestones that culminate in a Blueprint in 
December 2007

VODS High Level Milestones
October 29, 2007 to November 2, 2007 Planned Playback Sessions
November 29, 2007 Prototype Complete
December 7, 2007 GM Gap Analysis Complete
December 18, 2007 VaxNet and GM Blueprint Complete
December 2007 through December 2008 Pan Flu Workshops and Blueprint
December 2007 through December 2008 Pan Flu Support

Slide 23
The future plans will be solidified by 1st Quarter, 2008 
•	Complete VODS phase 1 by December, 2007
o	Prototype
o	Fit Gap Analysis
o	Blueprint
•	Continue with Pan Flu Support 
•	Solidify plans for moving forward with phase 2 
•	Guiding principles
o	Reengage the Grantee community
o	Use standard Accelerated SAP (ASAP) methodology 
o	Targeted toward “out-of-the-box” SAP implementation

Slide 24
Today’s Agenda
•	VODS Update 
•	Plan for Reengaging Grantees
•	Questions and Answers

Slide 25
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

Slide 26
Questions?

Slide 27
Appendix

Slide 28
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
o	VACMAN 4.3 released in October
•	During last update, it was stated that Grantees and Providers could expect the following:
o	Grantees place provider vaccine orders on behalf of the provider and also Grantee-funded bulk vaccine orders  Has been occurring
o	Order receipt data will be sent from Distributor to NIPVAC and accessed via VACMAN Provider receipt screen   Has been occurring
o	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

Posted to the website 1-28-08

This document can be found on the CDC website at:
http://www.cdc.gov/vaccines/programs/vmbip/downloads/prog_mgrs_mtg/update-07-mtg.rtf