Strategy: How to Win with Today's IDNs and GPOs

Unknown Speaker  0:48  
Like I said, clap for John.

John Strong  0:51  
Well, thank you very much. I bet no one in this audience knew there was a healthcare supply chain Hall of Fame. Right? I'm living proof there actually is. We've got a very distinguished panel this afternoon. And we thought it would be fun this this year, for you to hear what happens at the point where you're ready for commercialization. And you're ready to go out and start talking to hospitals and integrated delivery networks, and the sorts of things that they're going to be asking you for, as they begin to evaluate your technology and products. So we have three distinguished panelists this afternoon, and I'll let them each introduce themselves. We'll start down at the end with Darren, do you want to tell us a little bit about your company and your role?

Darren Vianueva  1:33  
Absolutely. First and foremost, good afternoon, everyone. John, thank you for having us here today and top of the Day to everybody else. My name is Darren Vianueva. I'm the senior vice president technology sourcing and integrated support services for Trinity health. Trinity health is a faith based, 93 Hospital Health Systems spanning 22 states from coast to coast, we have revenues around 20 billion supply chain costs around $8 billion on an annual basis. My areas of responsibility under Support Services are multitude of things like environmental services, food services, dietary facilities, capital project management, capital construction, but the two areas that I think that you'll find very interesting that are also under my responsibility is medical devices, medical devices, cybersecurity, and then a group that I have that we call technology sourcing. So one of the you know, the big challenges is as you're starting to bring new technology into an organization like ours is that cybersecurity is one of those things that has really become one of the forefront things. And we're going to talk about that a little bit more today because there's both the opportunity for competitive advantage for you. And there's a ways that you can kind of slingshot if you will passing your competitors because the legacy costs as they have. In the technology sourcing part, we run basically a group of sourcing professionals that focus on medical devices for the organization, somewhere between around $750 million if you on an annual basis. And then we also source basically all the IT hardware and software applications for those that are in the the IT side of the house. So in turn that represents about 1.5 billion just by itself. And with that, I'll turn it

John Strong  3:07  
back to John. Amanda.

Amanda Chawla  3:09  
Thank you, Darren. Thank you, John, for having us. Amanda Chawla. I'm the chief supply chain officer for Stanford healthcare, serving Stanford Medicine. Stanford, as many of you are aware is located in the bay area such as right above us. In terms of scope and services. I've been with Stanford for a little over six years. My background comes primarily from healthcare, I've ran supply, small organizations, large organizations, for profit, nonprofit ran clinical trials, private practice, etc. At Stanford, we have when you're looking at Stanford Medicine more broadly, Stanford is made up of multiple legal entities from the adult hospital Stanford healthcare to the pediatric hospital as Lucile Packard Children's Hospital and we've got our community hospitals, we've got the School of Medicine, and other entities, each one of these entities operates independently. So we've got independent governing boards supply chain happens to be a shared corporate service across the entire system. That is not the case for the rest of the functions. Having said that, when you look at Stanford Medicine more broadly, we make up about $15 billion in revenue $2 billion of non labor spend. My role is to procure, oversee all non labor spend purchases. So whether that's purchase services, or whether that's goods or products, all of that comes through supply chain. And so our big focus really is on this non labor spent program where we are looking at expense management, we are looking at efficiency, we are talking about value more broadly as a system recognizing the individual individual operating entities.

John Strong  4:42  
Great. Thanks, Amanda. Jimmy.

Jimmy Chung  4:44  
Yeah, thank you. My name is Jimmy Chung. I'm been a board certified general surgeon for about 22 years. My current role is Chief Medical Officer of Advantus Health Partners, which is the the supply chain organization under Bon Secours Mercy Health, which is a just under 50 hospitals, mostly on the East Coast and Ireland. Kind of a strange combination. But it is a faith based organization, about a $10 billion annual revenue. And most like most large ID ends, there is a centralized, shared service for supply chain, we're doing something a bit innovative, which I'm sure all of you are familiar with, which is to spin off the supply chain organization into its own company, we kind of want to call a high value GPO Plus model. So we'll talk a little bit more into into that. But basically, I know most of you are probably familiar with group purchasing organizations and some of the challenges that that they that they have, in terms of developing or accepting emerging technology. And we would like to do something different that provides value to both the suppliers and the provider partners that we will be working with. So currently, mostly Bon Secours Mercy Health, but are we're developing a model that's going to be modularized, and be helpful for other hospital organizations. So I'll pause there, and we'll continue right.

John Strong  6:26  
What you're going to hear this afternoon, I think, is really thought leadership from three people that are on the front lines of supply chain in the US today. And I consider these people really forward thinking in terms of the way they're approaching the supply chain and looking at new technology. And one of the things that I'm sure if there's folks in the room that have developed products and new products, you get to the point of commercialization, you've defined your value, and you're excited to go in and start calling on customers. And these folks are going to be able to talk to you a little bit about how their teams look at that value proposition out in the real world. And so the first thing I thought would be interesting is for him to have each one of them talk a little bit about their perception of what that value is, what what is value? It's certainly not price. But what's the underlying value to a healthcare system of the technology that you're bringing in? So Jimmy, you'd like to start?

Jimmy Chung  7:26  
Yeah, I this is probably one of my favorite topics. So I think when it comes to value, you know, I don't I don't want to insult anyone's intelligence, but you know, you really have to define who the customer or customers are, I think most of you are probably familiar with selling to, or trying to develop products that are being sold to hospitals, or maybe surgeons or other care providers. But really, in my mind, the ultimate customer is the patient. And so the customers that you have in transit along the way, are the enablers that bring the technology or the solution to the patient. And so, in order for us to really define what value means down the line, you have to think of what who the customer is. And I think there's a famous Peter Drucker quote that says, the customer rarely buys what the company thinks it's selling them. And in this case, it's quite true as well. Because when you you know, let's say, you know, if you're selling, let's say, your Stanley and you're making hammers, and you sell them to, you know, Home Depot, and then a customer walks in, and the Home Depot sells that person a hammer, you know, what is the the Home Depot has sold the hammer, but what is the customer buying, you know, marital bliss, because they're buying a hammer, so they can, you know, hang the wedding picture on the, on the wall. So if you're if you really understand what the customer is buying, in this case, marital bliss, then an innovator might make well what if we can have a way to hang pictures without nails at all, they don't even need a hammer. In healthcare, it's much the same way that the what the ultimate customer the patient really wants is not usually visible to you guys, because you're focused on selling the product to a hospital, and maybe the hospital knows. But even sometimes the hospital doesn't know what the patient really wants, you know that you may be selling a knee implant to the hospital with the customer, the patient doesn't go to the hospital shopping for a knee implant. They go in because they want to be able to walk, you know or dance or you know, they want freedom. That's what that's what the customer really wants. So I think long term down the line when you think about value, you have to think about what's valuable to that ultimate customer and the reason why this is important is because as we migrate from a fee for service volume based healthcare model to a more value based model, hospitals are going to be thinking the same way. And when I say hospitals, I'm talking about provider organizations because they also outreach in a ambulatory way. But as a value based model becomes adopted, hospitals are actually going to start losing money if they do more too many cases. And so they have to think about what's the ultimate outcome that that's important to the patient, and then drive their financial strategy based on that. And that sometimes means doing fewer cases, and doing fewer, high complex and high, high high cost procedures. And so you need to have an understanding of what that means. You need to understand what the wave is that's coming. Are you surfing with that wave? Or are you swing to catch up to that wave? The wave is value based care? And you have to be aware of that in order to understand what value to that ultimate customers to the patient.

John Strong  11:04  
Darren, I see you down at the edge of your chair there. Do you agree with Jimmy or?

Darren Vianueva  11:08  
Yeah, I do like to add? Absolutely. You want to put it kind of in layman's terms, when we talked about value, it's really helping us solve the source of pain. You know, that source of pain can be many different things. But you know, generally speaking, we're looking for things that basically create a better environment for patient safety. We're looking for things that for example, in the med technology arena that basically can integrate to our organization plays well with other applications, has scalability, you have resources to deploy, you know, things that are created to the bottom line, we're definitely looking at things that help with patient throughput are things that we look at very carefully. But generally speaking, when we look at value, we look at it from a multitude of ways, you know, kind of the old days, if you've been in healthcare long enough, you know, at one point in time, there was a single decision maker that would look at something and make a decision. Next thing, you know, we were ordering it. In today's model, that's it couldn't be farther from the truth. Most organizations have adopted, you know, either a value analysis process or other things that help basically cross discipline teams in the organization come together and look at basically new products, new technology, to look at it from a holistic standpoint, to see how it fits in the organization. And that's really probably one of the key things to take away from this is that, you know, when you're when you're, when you're coming in to make a sale, if you will, is, you know, there's, there tends to be a lens, if you will, based on whoever the founder worlds or whatever the tech is, it kind of looks that singular lens, but understand that you're selling to a cross discipline team of everything from nurses, physicians, financial people, IT people, clinical engineers, supply chain, it is a large group that is looking for what is the best products, because at the end of the day, you know, like most things, we have limited resources. So there's only so many things that we can engage on. So we want those things that basically will help us leapfrog our competitors as well.

John Strong  12:54  
Great, Amanda, let's say you,

Amanda Chawla  12:56  
you know, Jimmy and Darren, and both have done a phenomenal job describing it, you know, the thing that I want to reinforce and add is the fact that there are so many different perspectives, it is a multidisciplinary approach in the evaluation and the selection of technologies. And of course, cost is a component. But then there's this cost of there's this component of efficiency, how is it making our lives easier? How is it helping us whether it's that competitive advantage, or whether it's the integration? The other piece that I think is really important in the value is what what problem is this solving? What problem is this technology solving, if we aren't clear about that, and in this multidisciplinary team that you're pitching to, you aren't clear on what it means for that physician, or the IT personnel or the med tech personnel, you've missed the value component. I mean, when you think about value is cost, quality, efficiency, service, etc. It's an equation across all of it. But I think most importantly, it's understanding the audience, and what your product is doing. And what is the proposition of this product? Why is this even needed? And so being able to articulate what problem it's solving is really, really important.

John Strong  14:07  
Great. Darren mentioned, the value analysis committee and in my experience that can be your best friend, or in some cases, maybe not. And So Amanda, maybe you'd like to start and maybe sort of demystify for the audience a little bit about what the vac does. And we'll let the gentleman jump in then with maybe some key points around the value analysis committee.

Unknown Speaker  14:27  
Yeah, so value analysis, or whether you call it something else, value based selection, really is the central approach to bring in medical supplies to bring an innovative product to the organization. Having said that, I think it's really important to understand each organization scope of their value analysis. When we say value analysis, it doesn't necessarily mean the exact same thing from one organization to another. Some organizations have adopted the technology components, some organizations have adopted the innovations component. So that's one thing that I do want to clarify. The reality is from a value analysis perspective, to be able to introduce products, it's a multi prong approach. It's that approach of working with that clinician or your primary stakeholder, whether it's with whoever the healing hands are that that's going to use your product, the supply chain, and then being able to recognize this product also has a technology interface, or it has this, that's, that's the group of people to work with. And when we're talking about value analysis, typically that's administered from a programmatic standpoint, by supply chain as a facilitator, but often organizations have operational or clinical or technical leaders, depending upon the different subcommittees or their complexity of value analysis. So I do want to clarify that. The second thing I want to talk about for value analysis is each organization has their own process. So whether they use a certain technology to submit, I think, really the key here, when you do submit is being that being able to differentiate, being able to demonstrate the need and making sure you have a strong champion, if you don't have a strong champion going into in with you through that value analysis process, it's going to make it much more complex, because of the complexity of the processes.

John Strong  16:19  
Jimmy, thoughts on that?

Jimmy Chung  16:21  
Yeah, I think Dan, Oh, yeah. Plenty.

Amanda Chawla  16:25  
Jimmy can spend an hour here on this.

Jimmy Chung  16:28  
We go way back. Well, I again, at the risk of insulting somebody's intelligence here, I just want to like really break it down to the basics. So in supply chain, in the supply chain management, you know, organization within the hospital organizations, value analysis is seen as the sort of the the clinical pitstop. Okay. It's where things are, when when items are procured, and then they are identified, and before the final contract is, you know, is signed, it goes through the the clinical validation as to like, is this something that physicians really need, and how do we maximize the value before then we tell the, the contracting folks, you know, this is, the better the best scenario or, you know, and so forth, or we need to have two vendors, we need to have one vendor or five vendors where that kind of that kind of clinical decision making process, the the challenge there is that value analysis would be much easier. And I get to say this, because I'm a physician, if it weren't for the physicians. Because if you don't already understand this, physicians who work in a hospital, are often in probably the majority of them are not employees of the hospital. This is a very strange business arrangement, where you've got professionals who are allowed to walk into your building, if you're a hospital administrator, you got professionals who can walk into your building, get privileges, to do surgeries, or take care of patients in your building, and you have no financial agreement or arrangement whatsoever, in fact, in most states illegal to do that. And so the hospitals have to figure out a way to, to really figure out a way to maximize the value of products that they purchase, but at the same time get the physicians buy in and then the physicians have to talk to that hospitals. Well, we think this is the best product, or I think this is the best product and I want to do it my way. And then the hospital has to either decide, Okay, do I give in? Or do we use a very strict value analysis process to limit what physicians can ask for? So that's kind of the basics of physician lead value, or physician item, value analysis procedures. For a lot of products that we call commodities, that physicians generally don't care about, they go through the process very quickly. Because they just have to be validated, you know, is this something that works or not, and then it gets, then we look for the best value working with vendors, but for a physician item. That's, that's a constant battle. And so what we are what most hospitals are now trying to do is to have a value analysis component that has physicians involved in it. And so, if a physician let's say a high volume physician wants something and they asked the hospital for it, a lot of hospitals will just get it because they don't want to lose that surgeon. They don't want to lose him to lose him or her to the competitor down the street. And so they will often just say, you know, well, whatever you want, we'll get it for you. And you know, I'm speaking from experience. So that still happens. But that is not a sustainable model. Reason why I mentioned this is because I know a lot of lot of supplier vendors use that technique technique to get into the hospitals, they will find a physician, butter them up, say, hey, you know, with this new technology, you know, you're going to be the first one in town to be able to do this, you will be an innovator, again, speaking from experience, lessons learned. And then you argue with the the hospital, hey, why can't I bring this in, this is great technology I want to bring it in, those days are going to start disappearing because most hospitals have realized that they have to centralize the process to maximize value again, downstream to their customer who's the patient. And they have to find a way to align with the physicians. So more and more, you'll see more physician engagement into the value analysis committees, some of them are actually physician led with physician panels, that's probably a better, better way to do it. So as John mentioned, using that kind of procedure or process, it actually makes it more difficult for emerging tech companies to get their foot in the door. Because a lot of times, the effort of value analysis committees is to centralize and standardize to the best, the best value that includes quality and outcomes over cost. So if you can't compete with a larger company that can really minimize costs due to their size and economies of scale, then, that is a huge challenge for you. And so I'll pause there.

John Strong  21:43  
And if you'd like to respond to that, and maybe also talk a little bit, I think Jimmy hit on an important point here. And that's where you start down the process. And Darren maybe you can comment a little bit. I've heard at this, this conference, in particular, that most of the target audience is physicians? And is, is that really the right place to begin? Or are there other things in your organization at Trinity, Darren, that should be followed first.

Darren Vianueva  22:07  
So I'll come back to the points that Jimmy was making and just kind of expand on a little bit, it was kind of articulate is that basically the size scale and scope of the organization that you're seeking as a customer has much different resources and much different processes. So as you start to engage them, understanding those processes will make your life a lot easier. And it'll make the process to get into the organization much simpler. So for Trinity Health, we have the you know, traditional value analysis process. We also have an innovation arm where basically we will actually make seed funding for certain basically organizations to help them move along if we think there's a value prop there, that's going to help Trinity. So we've you know, and again, it's good, it's really going back to the point that Jimmy was making is basically making sure there's enough avenues that as physicians are engaged that they can point in a direction of what they see as value so that these different groups can start to basically identify, assess, and then put into a pipeline, if we're going to move in that direction. So we use value analysis, we have a supply chain portal that allows any supplier to basically sign up for a meeting, you know, present their information at the same time, they can download all of our documents on process and how to get into the organization. We also have what we call these clinical excellence council. So basically, their specialty, so like robotics, if you will, orthopedics, spine, all unique physicians from across the organization that are specialists in their space, they will assess new technology. And they will help feed if you will supply chain and what things we should be looking at. So again, that's a difference in scale and opportunity. From a process standpoint, generally speaking, if you engage with your customers, and you look at how they basically engage with suppliers, you're going to find a huge degree of variability. The smaller the organization, the more they stand alone, themselves in the sense they don't belong to another larger health system or having affiliation they tend to buy in their own, their process will be dramatically different than a large organization. With new tech, you know, this is just my view of things. And what I've experienced is that if you're really bringing a new tech to the environment, your smaller standalone hospitals are going to be the least likely to engage you because they're not going to have the resources to assess. So going to the larger organizations. And again, when you look at processes very important to understand that it may it may be received very well by physicians but if you look at it from an integration standpoint, scalability scope, you know, a lot of things that have really disrupted our processes in the last couple of years has been cybersecurity, anything that connects a network anything that has Bluetooth, it has to go through a very rigorous process. So even though you may have the best technology, if it or if it offers a risk to us that is substantial, we will not buy it. And the flip of that can be also be true. And what I mean by that is that if you have technology that competes with somebody else's, is similar nature, but your device has a much stronger security profile. We will then buy that device at a higher cost and I know that's terrible as a supply chain person to say but each Just want to understand that there is so much emphasis right now on security in the environment because our liability is so much higher. When you look at a personal financial record, the black market price is about $5, when it comes to a patient record is $54. We have been slow in the sense of embracing cyber security because until about 2016, we really didn't understand how it really threatened medical technology, and then Wannacry came along, and it really kind of opened everybody's eyes up. So in turn, understand the process, understand it's a very large cross discipline team. No longer will you see a singular physician or even physician group say this is the direction we're going, it will always be in large organizations cross discipline teams.

John Strong  25:44  
Amanda, do you have a merging technology function at Stanford,

Amanda Chawla  25:48  
we do, we do. And I should have mentioned that we have what we're calling kind of our catalyst group. So similar to Darren, we do do seed funding, we do do some joint investments. It's interesting, though, to just listen, because it's the same thing I consider Stanford, probably a midsize organization, we're not very large. But part of our core mission is innovation. And even as part of our value analysis program, one of the aspects in our value equation is our commitment to innovation, our commitment to innovate our commitment to transform the way that we operate the term to transform the way that we do our business. And so even as we're having products and technologies now come as part of our value analysis programs. And again, we have different subcommittees and instructors. Because the physician product is very different than a general med surg than a biomedical equipment, this conversation and this discussion around integration is so important. So I do want to stress what Darren has said about cybersecurity. But I would also add on the integration and the value proposition of what that product provides understanding and knowing that is going to be really, really important through the value analysis process.

Jimmy Chung  27:02  
Yeah, I would just add that Bon Secours has a similar innovative, or innovation, arm and group, I would say most large IDNs. And maybe academic centers have an innovation, you know, division or arm, you know, venture capital available and incubators and things like that. So it's not, I think a lot of the larger hospital organizations are really getting into that act so that it's not quite as difficult as it used to be.

John Strong  27:38  
So one of one of the things that I thought we might delve into for just a second as the amount of time the processes take, we have investors here, we have inventors here. And as ASPI has gone out and started working with new and innovative technology, we've discovered that shortly after they get their investment, the investors want to know where the sales are. So can you talk a little bit about the length of time that it sometimes takes to evaluate products make decisions? In a hospital or a complicated, integrated delivery network or health system? I'll just throw it open to the panel.

Amanda Chawla  28:14  
So I can start off? I'll start off with the answer. It varies. Many have used word value analysis is bureaucratic. We've talked about it from the point of view viewpoint of it's multidisciplinary, it's multifunctional, it can take months, months to get a new product in, and sometimes even longer, depending on how what's the level of innovation. I mean, if it's a brand new scale of innovation, we'll want to do a trial, we'll want to do an evaluation. We have to, you know, do a lot of testing, sometimes it has to go through the technology boards of reviewing, you know, the cybersecurity components. So I've seen products as less, probably the most, from an innovative standpoint is 60 days, maybe 90. If I'm as the fastest, that's really fast. But I've seen products go out and take almost a year to get through the process.

John Strong  29:12  
Okay, Jimmy? Yeah, I

Jimmy Chung  29:13  
don't think that's too far off. I mean, if you can get something through and 60 days, that's great. But I think it really depends on the different pathways that you're taking. So if you have a product that's already been, you know, through the development stage, and now it's ready for marketing, you just want to try to bring it in as a new product to compete with whatever the hospitals already using. That could take actually longer. Because if it's, for example, a product that competes in a category, that the hospital already has a contract with other, you know, other companies, then you'll have to wait until that contract expires which could be two, three years. So your chance to get into that RFP might be several years before you can actually even, you know, show your value. Now, if you want to bring in a niche product that is in the same category, but does something different, then you would go through the normal, that what we call a new product, introduction or new product request, which is got, which goes through the value analysis process. But that could be a little bit faster if you demonstrate that this is actually something that can be carved out. Because the competing company that has the contract with the hospital organization doesn't provide this, you know, sometimes like pediatric products can make it through that process because there's some all they're smaller size, or a product that's designed for a particular patient population. For a particular disease, state, those kinds of things can make it through, if you're talking about bringing a product that's still in development, and you want to partner with a healthcare organization, again, that incubation or in development, co development of that product might go through their venture group, which could take actually very quick, you know, that could actually literally take weeks, or maybe a few months. But that doesn't mean that it's now in you know, in full commercialization mark, you know, production, it's, you're still developing it. So for that to then be fully developed and fully baked and then used out in the in the real world. You know, that could take, I don't know, that could just have to take months to years, really,

Darren Vianueva  31:37  
To further a little bit. And there's some great points is that the contract cycle for a lot of large organizations is somewhat driven by their group purchasing organization. So for those that aren't familiar with what a group purchasing organization, it's like a farmer's Co Op, if you will, in turn, because they drive the contracting cycle, by engaging with the customer. And also some of these group purchasing organizations, you can get a better lay of the land of what customers are gonna become targets at what point in time, the beauty of that is that just GPOs you know typically based on their size come representatives from 20% to 25%. of the industry. So that gives you a great opportunity to understand when your next big opportunity is with a very large swath of customers. The contracting cycle, it's it's you know, to my peers here at the same point, it's, it varies, it depends on what the product is, and which basically funnel in our organization is going through, if it's going to our innovation arms, there's we already have standard templates, we can usually move something through and 30 days or less, if it is significantly complex, and sometimes can be disruptive at an enterprise level, it may take up to a year to get it through. If your product is commercial, and is competing in the marketplace, and we are running an RFP, our typical RFP processes 120 days, that's our target condition. Again, depending on complexity can go out to 180 days. So I mean, understanding your customers understanding their contract cycles and where you fit in that will, it will ease a lot of the pain. Most importantly, it will create a value lever for you on where to place your sales efforts versus just kind of doing it randomly.

Amanda Chawla  33:08  
The one thing that I just want to throw in there and add is you've heard us talk about time and different ranges of how long products can take. But oftentimes you go six months, and that doesn't go through. So just because it's gone through the value analysis for three months, six months, nine months or one one year or longer, doesn't necessarily mean that the product will be adopted, because of the level of complexity, the amount of stakeholders and really the multidisciplinary approach that's used in at least large systems in the evaluation of products.

John Strong  33:41  
Great, it's I think it's really important for for folks that are thinking about commercializing product to really understand the strategy behind using group purchasing organizations or not. And there are three nationals left. Darren, you're part of Health Trust, I think, Amanda is part of Vizium. Correct. And Jimmy your )remier,

Jimmy Chung  34:02  
currently Yes. That's right, in transition.

John Strong  34:06  
So those are I mean, those are really you've got representatives from all the US all three national GPOs here. So it's really something that needs to be taken into account at the time you're building your strategy. Let's talk for a minute about sort of pitfalls. You look at great new technology, people come into your organizations. What are the types of things that you've seen, that these folks could learn from that they should really avoid?

Darren Vianueva  34:37  
I think the first thing is having a good, concise presentation, if you will, that first meeting. The first meeting is everything. You know, generally speaking, I know one of the things that we were talking about last night is you know how much of the virtual world is going to stay? You know, do we think that the virtual meetings will continue? I think the first sales presentation if you will, that first introduction to the organization will become a mainstay, it's more effective, it's quicker, you know, I think for the suppliers as well as us, it offers less costs, the actual, what I call the technical assessment, especially if you're selling medical technology, there's going to be a need to still see touch, feel utilize it to understand it. One of the things that I had learned during COVID is that even though we weren't taking in person meetings with suppliers, we were having them drop equipment off so that we could evaluate it before we put it into the production environment. So I you know, if under those circumstances were basically you know, everything was extremely rigid, we were still having equipment brought in so that we could assess touch and feel, I just don't see how that's going to go to a virtual environment anytime soon. Could be wrong.

Amanda Chawla  35:44  
So I'll go back to kind of the pitfall question, I think one of the biggest pitfall that I see is not being crisp enough, and to the point around what your product is selling, like, what problem is it really solving, doing your research, knowing my organization, knowing where the weaknesses are, knowing who my competitors are, where their strengths are, where you're bringing, not just industry data, but you're bringing data that's relevant, which assures me that you have done your homework, you know, our organization, and that you've done some evaluation of your own research that this is, this is valuable time that we're going to be spending together. So I think that first 60 seconds, that first meeting, can't underscore the importance of that. But also doing your research, knowing the organization being clear on knowing what are my priorities, you know, as Stanford Medicine, what what is my physician here looking for? What is my IT person looking for? What is this person, knowing who is in that room? And what's important to them? And making sure you bring that out in the conversation? And then the presentation of your products, I think is really important. And if you don't know the answer, be honest, hey, look, we don't know yet the value proposition here we are, we don't know that just being very clear, being very direct, and doing do spend the time to do the research of the individual organization. Also understand what what the competitor is within my organization, not just nationally, because a lot of times I've listened to sales pitch, and I'm like, we don't even use that we don't care, we've got this other thing. And you had no idea. So that research piece is really important.

John Strong  37:32  
Jimmy, any thoughts on that? Yeah, I

Jimmy Chung  37:33  
mean, just to build on that, and also my original comment that, don't assume that you understand the problem better than the customer. And, and again, know who your customers are. And at that point, when you're making your pitch or meeting, having that first meeting, there may be multiple customers, again, I emphasize, emphasize that the ultimate customer is the patient, and you need to have an understanding of how this is going to is going to meet the customer, your your patient's needs. But also, if it's something that is going to help the workflow of a nurse, then you need to be able to understand what that means. And so be able to express that but also to be able to say, not only we'll make the, you know, make your work better, but ultimately, your patients will have you know, fewer infections, for example. So that kind of understanding of what it actually means to to bring that value.

John Strong  38:31  
That's great. We're down to about the last two minutes. I know some folks in the audience may be interested in how they reach the non acute health care market, ambulatory surgery centers, large clinics, all sorts of different maybe it's retail pharmacy, other other types of health care provider, can you spend about 30 seconds apiece talking about your role in selecting product for non acute care sites or sites of care. It for

Darren Vianueva  39:01  
Us at Trinity Healthbased on scale and scope, if you will, is that we've been able to make it exactly the same. So we're using all the same councils Clinical Excellence councils, we're using the same value analysis process with the acute care is based on acute care space, it all comes to the same groups. So it's very simple. But again, as I think John's trying to bring to the point here is that basically, when you start dealing with other organizations, they may not have that same capability or resources, it's going to be kind of hit and miss. And you're gonna have to kind of discover what you know, what is the right process in those environments.

Amanda Chawla  39:30  
And I would say for Stanford, it's the same thing. It's one value analysis, one value based selection program, whether it's acute or whether it's non acute in the clinics and so forth. Because it is really that approach of the multidisciplinary team, and not thinking only just about the acute, but how does this transition to the overall care. So our approach is also integrated.

Jimmy Chung  39:51  
Yeah, the process itself generally is centralized for most larger organizations. Again, I think what needs to be recognized is that when as more complex procedures are becoming are migrating into different sites, so this is what we call a site shifting to when you're doing like hip surgeries in an ambulatory center, you have to understand the financials of that impact versus the fact that if you do that same surgery in a hospital, it becomes a cost center, not a revenue center. So think about the differences between what are you going to say to somebody who's moving these cases over to an ambulatory side as opposed to somebody you know, at a hospital that's continuing to do those cases in, in a hospital.

John Strong  40:36  
That's great. Well, we're almost at double zero. So I like to ask you all to join, join me in thanking our panel this afternoon for some insight into the complexities of commercializing product out in the real world. Thank you guys.