Understanding the IDN Buying Process Through the Eyes of a Supply Chain Leader
Mike Langlois is a Supply Chain expert, working his way up from the bottom to become Senior VP of Supply Chain for two large and widely recognized Integrated Delivery Networks (IDNs), Ascension Healthcare and Beaumont Health. He helped develop the strategies and tactics for the groups and introduced some truly innovative programs. In this episode Mike takes us inside the world of supply chain in an IDN and helps us understand their challenges and opportunities, and how medical device companies fit in. Some of the things covered were the best way to introduce a product, how to build an effective relationship, what you should be asking your customers, if your customers are talking to each other, and what happens in the middle of a contract when things change.
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Episode Transcript
This transcript was generated using an automated transcription service and is minimally edited. Please forgive the mistakes contained within it.
Patrick Kothe 00:31
Welcome. The buyer-seller relationship, there is a ton to be explored there. It's unique to every market that relationship, but they also have, you know, a few constants within them. When you look at this relationship more as a partnership agreement, not an adversarial relationship, it's going to be much better for both parties. I am really happy to have Mike Langlois, join me for our conversation today. And he's and we're going to be exploring the relationship from the buyers perspective. Mike is really seen it all he's worked his way up from the bottom to become Senior Vice President of supply chain for two large and widely recognized integrated delivery networks or IDNs, Ascension health care and Beaumont health. Mike helped develop the strategies and tactics for these groups and introduce some truly innovative programs, which we're gonna hear about later. So in this episode, Mike takes us inside the world of supply chain and an IDN. And helps us understand what their challenges and opportunities are, and how we as medical device companies fit in. So some of the things we covered were the best way to introduce a product, how to build an effective relationship, what you should be asking your customers, if your customers are talking to each other. And what happens in the middle of a contract when things change. There is a ton of great information in this episode. And I think it's really going to help in any buyer seller relationship inside or outside of our industry. I'll bet you're going to enjoy this one as much as I did. Here's our conversation. Mike, welcome. Thanks so much for being here.
Mike Langlois 02:34
Thanks, Patrick. Good to be here. Thanks for inviting me,
Patrick Kothe 02:37
can you give us a little bit of a backstory of how you got into supply chain.
Mike Langlois 02:42
I'm a hockey player. And I was going to go away to Ferris State when I was 19 years old to go play hockey and realize that probably wasn't the school or the decision that I needed to make at that point in time. I had gone to school for 1314 years at the time. And so I decided to get a job, my brother in law worked for St. JOHN hospital at the time in human resources and said, Hey, why don't you come, we'll get you a job in medical records. And you can take a year off and save some money and do what you want to do. So that's what I did. I was a medical record clerk for about a year. And about a year in I was going to go away to school again. But a good friend of mine now was the director of distribution at the time and said he was gonna open up a distribution warehouse, but we had a bunch of medical records on the floor. And so I got assigned as from the medical record team to help him put all those records on shelves so that we could free up enough space to put supplies in this warehouse. And he and I struck, struck up a still standing friendship. And he asked me, he says, Hey, you know, you helped me set it up, can you run it for me. And so that's how I got into supply chain, I started running a warehouse transferred over to distribution and spent the next 25 years at St. JOHN moving up the ladder within supply chain, it was called material management, the time went from running the warehouse into material control, which was kind of the technology side of it at that point in time. And then supervisor of distribution went back into purchasing got some experience in purchasing as a buyer, assistant buyer and the buyer went back into distribution and was the manager and eventually director and ended up being the VP of supply chain, you know, 25 years later. So that was I kind of grew up at St. JOHN. It was a chance decision not to go away to Ferris State University that ended up you know, in the job at St. JOHN and eventually supply chain. So wasn't planned. But you know, that's the way it works out.
Patrick Kothe 04:35
So what do you enjoy about it? I mean, you spent your whole career in it. What what what makes it so much
Mike Langlois 04:40
I organized carnivals in our neighborhood when I was a young kid, I just like organizing things. I'm a planner. I'm a list maker, you know, that's what supply chain is. It's really kind of organized, hopefully not organized chaos, but it's you know, it's a lot of organization I'm planning and making sure that product gets ordered product gets store product gets delivered at the right time. It's much more sophisticated than that. But certainly, the attraction of just kind of, you know, being involved a lot of things when you're leading supply chain for, you know, health system, you are involved in all aspects. And you know, from the surgeon that needs supplies to put in a heart transplant or defibrillator, you're you're involved in those purchases and making sure those supplies are there to you know, food to HR, even the pens, you know, we we talked about commodity products, and I tell you black pens are not a commodity product, because you change a black pen, a physician is not happy if he doesn't have the same black pen that he uses day in and day out. So there's just so many different aspects of supply chain and you get involved in so many different things. I've always said that, you know, hospitals like a small city and in supply chain, you're involved in just about every aspect of that, that city. And so every day is a little bit different. There's always something interesting to deal with. So it's just been a great career. I've just loved it. So great.
Patrick Kothe 06:02
So I want to go back to something you said because the way you phrase something was kind of interesting. You said you are a hockey player. You're not you were a hockey player. So tell me about hockey.
Mike Langlois 06:12
Yeah, no, I my dad was a big hockey advocate. You know, my brother and I played hockey, all our lives continue to still play at 63 years old. Just really, really enjoy it. I played a lot of different sports growing up, hockey's The only thing that I still do, quite frankly, I just enjoy it. I enjoy the camaraderie. Some people call hockey players a sect because we're kind of a little abnormal for most people, but but it's just a great sport. I enjoy it. It's, it's it's a great exercise sport. You know, I have friends that I grew up with playing hockey that are still friends today. I have a cousin, that's my age that we still play, we played all our lives together. And so it's just just a great sport, great exercise. It's a lot of fun, it's challenging, and still something that I enjoy joy doing at 63.
Patrick Kothe 07:03
When you grow up and live a sport like that there are life lessons that you take out of a sport and apply to other parts of your life. What have you learned from hockey that you've applied to your business career,
Mike Langlois 07:15
I'll share a very short story, I got a call from my boss, probably, I was probably a director at St. JOHN at that time. And he was doing he was doing my annual performance review. And he didn't know a whole lot about me. He had been, you know, my boss for a short period of time. He said you obviously played team sports when you grew up. And I said, What do you mean, he says, You obviously play team sports because you play so well, you work so well. you collaborate so well with everybody in the organization. And you're always looking out for their best interests and not your own. And so as well as I played hockey and ice is I think that's the ultimate team sport. I mean, you can't, you know, a pitcher on the mound is is in isolation quite a bit, you know, a quarterback, you know, needs a receiver but, and make the play on his own if he so choose. Hockey is just the team sport, you've got to play with the other five guys on the ice. And it's just so it's really taught me that, you know that and I think that's been reflective of kind of my, my desire to be really collaborative, and everything that we do, you know, within supply chain, we have to collaborate with clinicians, we have to collaborate with suppliers, with group purchasing organization representatives, our team members, our peers, all the way through your organization, it's just a necessary characteristic to be able to collaborate with folks.
Patrick Kothe 08:34
That's so well sad. And I think a lot of a lot of us who come through team sports really take that away. That really is, you know, how we get things done within businesses is to make sure that you understand whatever everyone else's role is, and treat them with respect and do coordinated activities not not being that lone wolf out there. So you started as a hospital. So there's there's a lot of terms out there. There's hospitals, hospital groups, IHD ends GPOs supply chain, so let's let's just talk about your growth, and the types of organizations that you work work with. And you started off as a hospital. But can you walk us through the hospital hospital group is ISDN Yep.
Mike Langlois 09:23
Yep. You know, I started at St. JOHN hospital, on Mac and Ross in Detroit, and it was probably a 400 to 500 bed hospital at the time, it grew to 630 beds, eventually, we we took over a small hospital about 10 miles north and B COVID. b started to become a system. We quickly grew from two hospitals to five to over a couple of others, you know, and we they call them mergers but they're only really kind of building a, what they call an integrated delivery network and IDN and so those eight hospitals Then comprised of St. JOHN health for a number of years. In late 99. The Sisters of St. Joseph who sponsored St. JOHN as well as three other Michigan based hospitals, or health systems, merged with the daughters of charity out of St. Louis to form essential health, essential became the largest not for profit health system in the country in 1999. And so, that was a challenge in a way that hospitals and 20 different states, Michigan being the most concentrated, given that, you know, the Sisters of St. Joseph had four different systems there, but they they again, they were spread out from Tucson to Lewiston, Idaho, Jacksonville, Florida, up to Michigan, Bridgeport, Connecticut, all over. So I was asked, given the st. john was the biggest what they called health ministry within the Essential Health Network. At that point, I was asked to participate in a group to really develop a supply chain strategy for now the newly formed essential health. And so we spent about a year kind of working on different aspects of contracting and value analysis. We thought about technology, and how do we pull our data together? How do we negotiate contracts, how we work with positions, all of that, so we built this kind of Ascension health supply chain strategy took about a year and then they asked me says, Okay, now you helped build it, you know, now you're going to come help execute that plan. And so I was s promoted to the VP of contracting and value analysis for Ascension health, worked for a great guy that was the CEO of supply chain for ascension. He was a CEO within three hospital system in Chicago at the time, and they were selling a hospital closing a hospital. And so he was asked to take over CEO supply chain. He was there for a couple years. And then he left and I was given the opportunity to serve as the chief supply chain officer for Ascension health for the next four or five years. That was just a great experience. Again, we had 72 hospitals at the time, it's much larger. Now we have 72 hospitals throughout the country. And again, it was a large IDN. And we were doing a lot of great things, the focus was really on providing no harm, making sure that we provided safe care throughout the organization we had. And so that strategy really kind of struck, you know, it went down to supply chain where we met with the chief medical officer, the chief nursing officer, consistently throughout, you know, my career, to make sure that we were making decisions that provided cost relief to the organization really are focused in supply chain, one of our focus has always been cost effective care, but making sure that we're still able to provide quality of care throughout organization. So we saved millions and millions of dollars, as a result of being able to collaborate throughout the organization really kind of bring our volumes together and negotiate contracts by providing you know, high volume of business to us to supply our base, and really benchmarking who's got the best price. And you know, we should be able to offer that to all of our, our hospitals within the network. So it really was a big, big task, big chore. But once again, that collaborated with the everybody the first four months that I was the chief splicing officer went and visited every hospital in the system and spend time with the CEOs and their executive teams and really kind of talk through what our strategy was, but then also what what do they want out of supply chain? What are they looking for a supply chain? What What can we do for them to really help kind of, again, further their business further their business model further their strategy further their quality patient care,
Patrick Kothe 13:38
let's dig a little bit into supply chain, what exactly is supply chain
Mike Langlois 13:43
supply chain, I mean, at this point, supply chain has really evolved into managing for a lot of organizations, all non labor expense, labor expenses for health systems are generally 50 to 60% of the overall expense, because of the intensity of really what we do is providing care, it's it's heavily weighted on on labor, unlike manufacturing a product where you know, kind of raw materials are a big, big piece. The next level of costs are supplies, pharmaceuticals, which sometimes are ball together and purchase services, which are again, depending on whether you outsource your housekeeping or you insource whether you outsource your dietary or, or you insource those are all purchased services that potentially you would have to negotiate contracts for. So essentially, you start with contracting for products and services that are used by the facilities, whether they're insource or outsource, you make sure that those products and services are at the right place at the right time for the right cost that are available to you know the clinicians to provide that that patient care. That really is supply chain we do it in a nutshell obviously Patrick, there's a lot more that goes on. Do it. You know, when you think about contracting your strategy around whether you, again, outsource or insource, a lot of hospitals use group purchasing organizations that combined volume spend with a lot of different hospitals or integrated delivery networks to negotiate with suppliers. It somewhat limits your availability to select those products, because you're in this pool of a lot of different hospitals. other hospitals choose to kind of go this go with themselves, or they think they have enough volume, they negotiate all those contracts on their own and really kind of self determine what products and services they they will use for their hospitals,
Patrick Kothe 15:40
simply is it procuring products and services, and then distributing product products and services are those the two main functions?
Mike Langlois 15:48
Well, those are and then between, you've got to receive them. So you know, receiving them from the suppliers, you generally have to inventory them whether you have your own warehouse, whether you use what is called a medical distributor, there are three four major national medical distributors that house products for you and will deliver your products on a daily basis. Other a lot of health systems have their own warehouses and get product directly from the manufacturers, and house them to themselves. And then you've got to move those products, whether it's from a distributor, to your receiving dock or from your warehouse, to the patient care areas. And so there's a lot of different ways to make sure that those products are the right products are available in the nursing units in yo RS in the cath labs to make sure that the right products are there at the right times for the clinicians needs.
Patrick Kothe 16:42
Like you talked about the early days of ascension and establishing the strategy of the of the supply chain group. What types of things were you thinking about in terms of strategy at that point?
Mike Langlois 16:55
Well, I think we had, we had three or four different groups, we had a technology group. And so you know, I was one of probably 15 different supply chain leaders that were on our team. And we divided it up into about four different sections, three or four sections. One was really around technology. And it was about getting the information that we needed the usage information that we needed to really negotiate with the supplier. So all of the hospitals were on different computer systems earpiece, different software packages that would manage their their supply chain. And so you had to bring all of that information together to be able to effectively sit in front of a supplier and say we've got we buy a million needles and syringes a year we want to negotiate, we're going to give you all of that volume. And you negotiate that with two or three suppliers to see who will really give you the best price and provide the best service, you have to engage clinicians to really understand, you know, what is usable, and what is not. There's certainly this crossover. But this technology is really important, we chose at the time to not standardize all the computer systems, but to build a data warehouse, and bring all that information into one data warehouse that would, you know, maybe be 80 to 90% accurate and really, but give us enough information and enough accurate information to negotiate those products. So that was really on the technology side. On the distribution side, we really looked at negotiating for a supplier, a medcerts supplier that would provide all of our products, whether it be just in time stockless, or in bulk. We wanted to negotiate again, much like we do with a manufacturer who went and negotiate a very aggressive deal with a national manufacturer that say, hey, you're going to provide us this at a very effective cost, because we're giving you a lot of volume, essentially was spread out into 20 different states, it was very difficult to do our own warehouse, because we were so spread out. So we really relied on, you know, this network of medcerts distributors to really provide us those products on an as needed basis. And again, we we had a distribution group that really worked that side of it. I was most involved in the contracting and value analysis side, which was really to develop a contracting strategy around how we would buy products and how would we determine what products we actually wanted to use. And so that value analysis process is really engaging to the clinicians into that that conversation. So we had value analysis teams that would emulate the 15 or so of us that were in supply chain, we would pull 15 or directors together for a couple of days and really talk about all the products that they use. And we did this on a monthly basis. So it wasn't just a one time shot. But we would pull 15 or directors together and really kind of talk about what where we could be effective in negotiating products and services that they use on a daily basis that we can consolidate through one or two suppliers and really negotiate them As price while assuring that we're providing quality products, you know for, again, the condition, so we emulated, we had an our team, we had a cath lab team, we had a lab team, laboratory team, pharmacy team. So we had about seven or eight different service lines that we will pull together again, some of them most of them monthly. Again, we fly into different locations, we also use those teams as consultants. So we wouldn't have we were based in St. Louis, but we wouldn't have those meetings in St. Louis, we would have those meetings at one of our sites. And part of the meeting would be for the director to do a show and tell and what they're doing in their particular role wires, so that you have 14 consultants free consultants to come in and say, Hey, what do you think about this, or when you think about that, and so pulling our director out of out of their operation for a couple days always seemed daunting to us. But our attendance was at 90%, consistently, because they just put value in networking with their peers, and also providing that consultative service for each each organization that hosted these meetings. So it was just a very, very effective strategy and plan. So I was most involved in that before I was elevated to the supply chain dishwashing officer role.
Patrick Kothe 21:19
So in the early 2000s, to now lots changed, changed over over that period of time. And I'm sure that the objectives of the group and the tactics and the strategies have have changed as well. So you're no longer there. But you, you went through through ascension, bomont, and other large, very prestigious group as well. And in general, things have kind of changed from a fee for service type model to delivering quality care as well. So we've got kind of different different objectives of the healthcare delivery system. How did that change happen within supply chain? And how did how did the choices and supply chain kind of move from knocking every every dollar out of it to making sure that the quality of care is considered in there, as well?
Mike Langlois 22:19
Well, we use the term total cost of ownership, which we never did in the past, you know, I worked for when I was in purchasing at St. JOHN, I worked for a guy that again, still a close friend of mine, but he was a purchasing director that just loved the beat up suppliers and his happiest days when when we're suppliers leave his office crying. And he would be proud to hear me say that, but we've we've we've converted to a much more collaborative strategy. Now we can't do things without, you know, the suppliers input. And so I think today, you're gonna find that where there's still competition and and so I'm not taking competition away, folks, you know, have told me your firm but fair, we put competition on the table and say, here's the business that you can you can get. But you've got to sell to us not only price, but what's the total cost of ownership? And so what does that do to our quality metrics, our care metrics, what does that do to you know, our patient mortality rates? What does it do for our length of stay? You know, what, what is it really what does that product, what type of impact is that product really having on our patients and on our conditions and the time that they spend with these patients and the the outcomes, we talk a lot about that. And it's not just who's got the lowest price. But again, we have to much more collaborate with the clinicians on this, but you're really getting into, again, results of clinical care as a result of using these products or services that you're negotiating for. And that's much more complex than just beating up, you know, a supplier to try to get another nickel off of a band aid price box of band aids, it takes again, much more collaboration, understanding patients, clinicians don't all agree with each other, you know, there's not a single care path that I found, take care of pneumonia in this country. So you know, everybody's got their own ideas. So you've really got to, you know, start with the objective that we all have our own ideas. But as a group, we're gonna come together and make a unified decision that's in the best interest of the patient. At the end of the day, and our patients within organizations and supply chains an integral part of that you'll see again, within supply chain our makeup, even our teams have now included physicians and clinicians. You know, some some organizations have positions on their supply chain, team, a lot of nurses on the supply chain team, because we just need to think like a clinician, we need to understand what the what the needs are. And so that's been what, what I would see is just kind of the major shift from my days, you know, at St. JOHN versus today.
Patrick Kothe 24:59
You hear from a lot of clinicians that they don't have a lot of input at this point with decisions on on different products. How can you assure that you're getting that physician input? Or what kind of types of systems do groups put into place to assure that you're getting that data input? And the physician doesn't feel like they're left out?
Mike Langlois 25:21
Yeah, you know, it really goes to what has been called value analysis. More more recently, there's a lot of different names for that. But it was most prominent as a value analysis process that really included physicians and clinicians, we established at Boma value analysis teams, and we required an executive and a physician to co chair those teams. You know, we did all the legwork in supply chain, we gave him all the information we provided, you know, give us direction, we'll go, you know, find out what's what, what companies are out there, what products are out there, we'll go do the research. But at the end of the day, we need you, an executive and a physician to be Chair of these teams, so that you can lead the discussions with other physicians, with other nurses with with other clinicians. And so they're much more involved, we've, we've just recognized that they have to be involved, they have to be at the table. They're not easy conversations. You know, we've had some very, you know, I've had to manage many heated conversations between physicians, you know, they just don't all agree, there is also a lot of ulterior motives, you know, a lot of physicians are on boards of manufacturers and suppliers. And so, you know, whether they are or not, the perception is that their opinions are tainted, and you've got to work through that they're high volume physicians. That's why they get asked to be put on these boards. And so you know, you've got to be very tactful, and how you handle kind of these discussions. But at the end of the day, and I wrote an article for the IDN summit not too long ago, I did some investigation of, you know, kind of the latest trends in orthopedics and cardiology. And both organizations, they did this, this, this research, have started to really kind of look at variability as kind of a nemesis. And and, you know, we've always said, you know, the physicians or clinicians have been trained in a certain way, they've all gone to different medical schools, they've been trained different ways been trained on different products, but they're starting to see that variability is is the enemy of great. And what I mean by that is, you know, if we have a care path, and you want to vary from that, you know, this care path has been established by a group of physicians, clinicians that say, this is the best way to take care of this patient. And varying from that only degra gates can have the quality of care. And so they're starting to see that. And so if we can kind of relate that to supply and supply usage. And what does that mean, for an organization, I think that's really where you can get the best of both worlds you can get, I think you can standardize on high quality, even high cost products, and still, at the end of the day be very cost effective. Because if you're providing better patient care, the patient mortality is better, the results are better, they're out of the hospital quicker, the cost of the product is insignificant compared to some of those, those results.
Patrick Kothe 28:26
So you've got hundreds of 1000s of decisions to make with with different different products and different things. So and you mentioned earlier about GPOs? Are those hundreds of 1000s of decisions? Is that a matrix of I'm going to I'm going to keep some of those as an in house decision I'm going to use GPOs for for other types of decisions.
Mike Langlois 28:51
Certainly, you know, and the degree really varies. You know, you have some that just blindly have no contract, you step and use all GPO contracts, that is just their strategy. You have others that don't even belong to a GPO and just negotiate they have their own staff. And then he goes on their own most, most ideas are somewhere in the middle GPOs were developed in the 70s as a result of having 5000 independent hospitals all different, right? And so the idea is let's pull a group of hospitals together and negotiate bigger with bigger volumes comes better price, we're going to negotiate and so you have this plethora of GPOs you know that again as the ID ends have developed and you know, you've got from 5000 to 3000 to 2000 different organizations, some are estimating will probably be down to 200 different ID ends, not in the not so distant future. The bill availability to negotiate your own contracts, especially for large large companies like ascension, which essentially has pulled out of a GPO and are negotiating their own contracts. With that size, you can really do That and make your own decisions and and support whatever strategy that your organization has. And then every organization has a different strategy that's somewhat important. And then you can also, again, support physician preferences, clinical preferences, but again, the majority are kind of using the GPOs for all their commodity products different than other industries, Patrick is we have very limited number of suppliers, you know, the automotive companies will put out a bid for fender and have 20 suppliers, you know, at the ready to build that vendor. According to specs we have. We have three IV solution companies, we have three needle and syringe companies. And so, you know, you can't just go and say, Hey, you know, I'm going to use some off the wall IV solution company because it just doesn't exist. So a lot of those commodity type products, you can just outsource that negotiation to a GPO, where it really becomes more sticky is your your physician preference items, we call them PPI items. It's really, you know, your orthopedic implants, your knees and your hips, your stents, your pacemakers, that becomes much more influenced by your physicians and you want to make sure that you engage them in that conversation. And if you're gonna engage them in a conversation, you can't outsource that you can't rely on what that GPO is negotiating. Generally, those physician sensitive items are are still negotiating contracted for within the confines of the IDN. Were most of the commodity products, the bandaids, the solutions, all of those things are outsourced to GPO.
Patrick Kothe 31:39
So what happens so you're a member of a GPO, and a GPO is contracted everything. But you want to say I want to, I'm going to peel off the orthopedic implants. Is it a different agreement with the GPL? And say, I'm only going to I'm only going to use you for these products, and I'm no longer going to use you for these products.
Mike Langlois 31:57
Yeah, you use you really start with the basics of a contract with a GPO how, how compliant Are you going to be? Generally you can be pretty flexible with a very basic contract. And what the GPOs have now come out with is committed programs that basically say, if you sign up for these 13 committed programs, and we can rely on you to support those 13 times, you're going to get better pricing than the average member of that GPO. That's a way of getting more contract compliance with the GPO. And then being able to assure whoever they signed a contract with whatever supplier they sign a contract with, that they're going to get that volume, so they can really negotiate with competence, the the volume that they have, versus you know, just a company that's, you know, a hospital is just going to cherry pick those contracts that they choose to participate in versus not.
Patrick Kothe 32:47
So upfront, you're, you're saying I'm going to commit to these categories of products, and I'm not going to commit to these other categories and products. Okay. So the categories of products that you are keeping inside, so the decisions that you're taking yourself, let's say it's a it's a hip product, or or orthopedic implant, what is the process for doing a contract for for those types of products?
Mike Langlois 33:19
Everybody's different, you know, but I can tell you my most recent experience with Boma we basically. And bomont was a three hospital system that grew into an eight hospital system overnight, we merged with a four hospital system in metropolitan Detroit and a single hospital and became you know, hey hospital system fairly quickly. And the challenge is the chief supply chain officer that you know, again, was to try to negotiate with physicians that didn't really know each other in some respects, they despised each other because they were in different organizations. And for whatever reason, they knew the, you know, the folks at Belmont are so there was some very heavy resistance in a lot of respects. But our challenge was to bring those those folks together really kind of talk through what what we should do, do we get down to one or two hip manufacturers or three hip manufacturers from eight or nine that, you know, maybe available that we may be using today? We really let the physicians kind of guide that strategy. What we did though, Patrick was we provided we set up a what we call the gain sharing program, and it was basically taking 50% of the savings that we garnish from their involvement in contracts. And we took 50% of savings. We put it into a fund that they could direct now they couldn't put it in their pockets that would create some legal issues. But they could direct those funds towards capital equipment or training staff or research project or a lot of things. There was about eight different categories of dollars that they could spend marketing You know, for their program marketing for the orthopedic program for bone out. So they were incentivized, and this was a big deal for them, because they always ask what's in it for me? Yeah, my first weekend on the job at Bowman, I met with the chief medical Chief of Surgery. And, you know, he asked me to come and talk to other section heads. And I did and talked about my strategy, what we did at ascension, and here's what I like to do here. And they, you know, I looked at me and said, well, what's in it for us? You know, I don't want just a better parking spot in the middle and a lot, you know. So that really kind of turned and it took a couple of years to develop this program, you know, we had to get corporate compliance involved and legal involved, and our CEO and cmo involved to really kind of put together what's in it for you, you can direct these dollars. So if there's a piece of capital equipment that we just can't fund, you can't fund through the normal process, you can direct this money towards buying a piece of capital equipment, as long as it's kind of within that structure of that committee that would approve that. So that became very effective. And, and for the first time ever, in my life, my career spanned, you know, 35 years by then, I had physicians calling me with savings ideas on how to save money, because they wanted a piece of that savings. And they had ideas in their mind, they already spent the money that they were going to save before they called me said, you know, Hey, Mike, I got an idea, will this meet our dangering program? criteria? And how soon can we get started on this, he goes, I got a piece of equipment, or I got a research project that I need to fund. And I need some dollars to do that. Some cases, we advance that money, because we knew that we were gonna save this money, and they wanted to get started. So it really worked out. Well,
Patrick Kothe 36:40
that sounds like a really innovative program was was that, you know, one of one of one at that point in time, we
Mike Langlois 36:49
have one that of the way was structured, there were some other gainsharing programs that that a couple of hospitals preceded us on but it wasn't structure, we structured it. Again, we collaborate with the physicians, and originally it started out is 25%. And, and I thought that was a lot. And one of the physicians that, you know, we're gonna play ball with you, we're gonna do this, but we want 50%. And I was like, no way. You know, after the meeting, I remember our CEO at the time, again, still a dear friend of mine, but he came in my office says, Why not? Why would we not give them 50%? They're spending the money on us, and you know, our programs? So let's give them 50%, if that's what they want. Okay. So that's what we did. You know, I did a number of talks on this program. Over the years. It was very, very successful. It was it really got the physicians to collaborate, even though they didn't like each other that much. And there were some tough conversations still, but but it was it was good. And then they helped us negotiate with the suppliers. You know, at the end of the day, you know, if we thought we need to get down to two suppliers in a particular category, because that's what was going to drive, you know, the savings that we needed, they'd step up and say, Hey, if we use these three, and we get these three suppliers down to the price that you need, we still get that savings. Is that okay? Sure. So they go make calls.
Patrick Kothe 38:12
So how do you decide what that number is? Whatever category so let's say there's 20 suppliers of a particular product, how do you decide what the number of products is to to obtain your objective and it sounds like you've got a couple of objectives in there, but price is certainly one of the main objectives there.
Mike Langlois 38:31
Yeah, it's, it's experienced, Patrick, it's 30. By 40 years of experience, you do your market research, you talk to your peers in the industry. And again, you know, I like in supply chain. It's it's a pretty collaborative industry, healthcare industry. We're a pretty small community. And you know, I have great friends even though I haven't necessarily been at, you know, at a IDN since 2016, when I left Boma, I still have a lot of great friends in the industry and and so we share a lot of information. We you know, the suppliers don't really like it, but we share information consistently. And so you'd kind of do your research, you say, you know where the industry is. And you want to be fair, right, Bowman was not the largest health system in the country. So I don't expect Ascension pricing. But I also don't expect you know, have worse pricing than you know, a two hospital system in northern Michigan. So you you kind of gauge where you think you can go and we stretch the limit. I had a I had at Bowman I had a VP of contract value analysis that was a clinician by trade. He was a pharmacist, he he was really, really good. I mean, he just pushed the envelope and as a result, Bowman was on a stage getting the top supply chain award for what was vizient University based membership. Year after year after year. We just really push the envelope, but I think we were able to push the envelope because our physicians have Someone's really gonna work with us on that.
Patrick Kothe 40:03
It's a point that you bring up about value or volume based pricing is really an important point. Because typically what happens in companies is you got a sales rep or a group of sales reps, who says I can get the business in this in this hospital or this group if I get if I get this price, but they don't realize that has repercussions if you get a lower price at that hospital, and then there's a larger hospital group that's not getting that price. Well, there's, there's there will be a price to pay. And as you said, People talk and what happens? from your standpoint, when you find that out? What happens to that to that manufacturer,
Mike Langlois 40:46
it depends, if I was told, once I was told, you know, 1000 times that we were being offered the best price in the industry. If that was truly the case, then they earned my respect, and we went with that contract. If I found out to the contrary, then I would do everything I can to dissuade us from doing business with that particular company. Again, it's about it's ever, ever ever again ever again. I I hold there's companies I still, you know, do not talk fondly about in, in private settings. I will say one of the greatest compliments I got was the CEO of Ascension at the time, saw me in the hallway asked me how things were going and just said, Mike, you're the person with the highest integrity that I know. That for me was one of the best compliments. And so I expect that from our suppliers, I'm going to be fair, I'm going to be firm, but I'm going to be fair, I'm not going to lie, I'm not going to bluff, I'm going to tell you the way it is. And I expect them to tell me the same. And I respect the manufacturer that says I can't give you the price that I can give a sanction. You know, if I'm sitting at Walmart, I can't give you that price. But if I'm an essential, there's not too many people that can come into me and say I can't give you that price. Because you don't have enough volume. I mean, we were there, there was a couple of for profit organizations, they have more volume than us. But we were able to provide the volume and the commitment that I expected the best price. And if I found out otherwise, yeah, there would be a steep price to pay.
Patrick Kothe 42:20
So one of the issues from a company standpoint is talking about commitment. And it's always Okay, we'll commit to this price with this volume commitment. How do you drive the the volume commitment within your group when you've got a number of different hospitals, a number of different surgeons who are physicians who are making making decisions? Because from a company standpoint, when the volume isn't there, now trust starts to erode, right? From that standpoint,
Mike Langlois 42:48
you got to get the buy in upfront, Patrick, you have to get that up front, you can vary. And the challenge that we would have potentially is you commit to that contract, and then the physician leaves new physician comes in. And you know, you've got to be upfront and transparent. That supplier just said, Listen, this was our intention all along, here's what happened. You know, I think they understand the complexities of an organization and that doctors come and go and, and and then if we don't deliver, and if there's a penalty be paid, and we should pay it, you know, I mean, we should just pay it. And again, it's about integrity, it's about standing up to your commitments and living up to your commitments. And so we did that a few times, I left some manufacturers off the hook on pricing, just because and you know, a lot of it, we started to structure it on a month, a month or a week to week or not week, but a month, a month or quarter to quarter basis that we would basically say, as long as we're meeting these commitments on a quarter to quarter basis, we'll do a quarterly business review. And we'll maintain that pricing. If we don't, then we come we come off. There are certainly some times where we basically said, we're going to use all of our best efforts to get to this volume. But you know, be again, open and transparent that says, hey, let's structure this, that we we get this pricing upfront for the first three months, if you can trust us, we're going to do everything that we can, we'll review it in three months. And if we can't live up to it, then we'll restructure the deal. And, you know, they respected that and, and a lot of times we fell short of it, and they said, we're still gonna give you the deal. You know, we're still gonna keep it because they know, there's that conversation, they don't want to lose our business. They know that we're working hard to get them the business that we committed to and so they're gonna do everything they can to kind of continue to work with us.
Patrick Kothe 44:36
So Mike, as you said, there's turnover within the physician group within within the supply chain people on the other side, there's turnover with national account representatives, as well. So, I want to ask you about relationships with companies and then with the representatives who come and talk to you. So How do you how do you keep that in mind? Because I'm sure there are, there are certain representatives that you think the world of that are high integrity people, but you also know that at some point in time, you may be dealing with somebody else, because they may get promoted or whatever. So how do you? How do you assess the integrity of a person? How do you assess the integrity of a company,
Mike Langlois 45:21
you know, you get to know the companies, you know, over time, and again, 35 years in the business, I know what companies are really out for themselves, and I know what companies are really going to want to work with, with us. There are some great companies out there that, you know, again, I would work within a heartbeat. And there are some great reps that, you know, we work with, and, and those two, usually match, you know, if you have a great rep that's working for unethical company, I'll call it or, you know, less than ethical company, they generally don't last too long, they can't tolerate that type of, and vice versa, you know, an ethical company is not going to not gonna keep an unethical rep for too long. So you value the relationship where, you know, there's, there's an ethical company that you know, has a representative that's been there a long time, you know, that that's a company and a representative that you really want to work with. But you can tell I mean, you can eat I can, again, it's it's comes with experience, unfortunately, you can read, I can read read a representative and whether he's being honest or not, whether he's being sincere or not, really few that can pull the wool over my eyes at this point in juncture so
Patrick Kothe 46:34
and it's and it's interesting, because from a company standpoint, we see the same things. We see the the groups that are ethical and do business the way that we want to do business with to and you may you, you may do a contract with somebody wants it, but if they're not holding up their end of the bargain, you're not going to give them the best pricing anyways, because you know, what the game is?
Mike Langlois 46:58
Right. So, you know, over 35 years, Patrick, I, you know, sign contracts with just about any country or company that has been in the business for that long, right, you know, I mean, just, you know, for different organizations and, you know, sign a lot of contracts and and i know those that are holding up their end of the bargain, I know that they're the ones that are not but you know, it's it's not an absolute either, I had a young, young representative for high end company that, you know, I was very suspicious about man, he was a, he was a good looking sharp, you know, good talk, well, kid, and I thought, Man, this is just a, this is just a used car salesman that, that I'm not sure I really want to work with. We become friends, we've stayed in touch. He since loved the company, he called me last week, he wanted me to do some consulting for his new company. He's a great guy, he was just raw, and he was learning the business. And so you know, you got to give people a chance. And and I'm all about giving people chances. Nobody's guilty until they prove me wrong. You know, I mean, they're just I give everybody the benefit of the doubt. But But Berman, you'll pay a price.
Patrick Kothe 48:02
Yeah, so let's talk a little bit about giving people a chance. Because within medical device, technology really marches forward, and there's new products that come out. And there's things that you don't anticipate when you sign that contract. So you make sign a contract for three years, and all of a sudden new piece of equipment comes out. And it may benefit your group. So how do you deal with new technology coming in and create enough flexibility and current contracts to allow people to assess different technologies coming in?
Mike Langlois 48:34
Yeah, I think, you know, first and foremost, you have to know the industry. I mean, you know, new technology just doesn't come doesn't just show up one day, it's, you know, it's in the pipeline, right? And so you've got to have the relationships with these companies and understand what's coming out. And so before you sign a three, four or five year contract, you really need to understand where, where the industry is, as a whole at essential. I was really fortunate in a lot of different ways. But we had, you know, a group, a strategy group that was constantly monitoring new technology, we actually it was essential health ventures, and they actually invested in a lot of development companies so that we would always go to them and say, Hey, you know, before we sign this contract, what do you see in this particular space, we would talk to the clinicians or the clinicians know, the physicians know, what's going on in this space. And you know, you earn their respect to that they're coming to you. And, you know, they're talking to you and they're asking you, Hey, can you go with us to the iris and a radiology society group? You know, we want to talk to a couple suppliers about some technology that's coming out. We'd like you to hear that, you know, and so they're dragging me along, you got to have your pulse on the industry. It's not just showing up every day and with your head. You know, in your computer, you really got to understand what's going on. And that comes with knowing the industry talking to suppliers. They should be the first ones to tell you hey, this is the You're out, you know, this, this particular technology you're out, physicians will tell you, and you should just be in the know. So that you don't get caught in that, in that particular predicament, it's just critical to be able to understand that.
Patrick Kothe 50:16
So the day that a product gets approved, and the sales rep has it in their bag, where do they go?
Mike Langlois 50:24
Well, we want to come to supply chain, you know, we've always been seen as an obstacle, they want to sell it to the physician, and so you know, if a physician will, will be their advocate, they'll, you know, they'll kind of carry their bag for them. We want them to come to supply chain, and let us manage that. And I think, you know, there again, there are some companies that understand that there's some companies of value that that, you know, they they basically will do a sell and then allow us to be the the door opener for them to the right clinicians, but you know, a lot of these representatives have long standing relationships with the physicians, you know, in their particular space, and they're going to go talk to the physicians directly. But you know, our mantra always has been and most supply chain packets for suppliers, they're, they're saying that all new products have to come through supply chain.
Patrick Kothe 51:13
What happens if they don't?
Mike Langlois 51:16
Depends on the product depends on you know, what the what that process is?
Patrick Kothe 51:21
I guess what, what's, what's the price to pull the
Mike Langlois 51:24
price to pay is it gets put on the bottom of the pile? You know, and again, it depends on I've had a lot of physicians come to me and say, Hey, would you take a look at this, Mike, but I'm in no hurry, okay, that goes in the bottom of the pile. And if you're no hurry, that means you don't really care if I ever bring this up, especially if if, you know, the supplier knows the process, and he backdoored it here, regardless of his knowledge of that. So, you know, there are some that, you know, are just brand new, I've had a lot, a lot of kids, a lot of my kids friends have gone into, you know, as a suppliers rep, and they're just trying to learn the ropes. And you know, you can slap on the hands and say, okay, you know, this is the way it goes. And don't do this, again, if they have a little bit of gray arm, I don't think that that's the case, I think they understand the process and, and they they're going to get more than a slap on the wrist.
Patrick Kothe 52:15
They're going to it's an informed decision
Mike Langlois 52:18
between they've taken the risk, and they're going to pay that pay the price for taking that risk.
Patrick Kothe 52:24
That's interesting. So Mike, are there certain dollar levels, where you allow different people to make decisions? So, for example, you've got a device and it's $20,000 a year for somebody to use it within the open heart surgery team, can that team make that decision? Or does every decision come through supply chain,
Mike Langlois 52:47
every decision becomes your supply chain, because those decisions may affect other products or pricing. Sometimes you have corporate agreements with particular companies that basically say, you know, we're gonna stick with this particular company, we're going to spend this amount of money. And and again, we're knowledgeable of what's going on, within, you know, a, an eight hospital group and bowmans case or a 70 aspell group, you know, more than 100. Now, with ascension, we're knowledgeable within that group. And so you just don't want to allow folks to go out and make those independent decisions that may affect and if they make a decision on a particular product that has a lot of shiny bells and whistles on it, but you know, our hospital down the street is using something less costly and more effective, we may know that they may not. And so you want to be able to share that information and stop at that bad decision at that point in time. So it really doesn't matter. I guess, you know, if it's a paper clip, I'm not going to get too concerned about it. But if it's a $20,000 piece of equipment, you know, depending on the size of the organization that can be significant.
Patrick Kothe 53:50
So somebody comes in and does it the right way, they come and talk to you and supply chain, you open a door, talk to a clinician and say this, is this a potential product? At that point? Do you do a trial of that of that? Or do you wait for the next contracting cycle to run through?
Mike Langlois 54:10
Well, I mean, we certainly want to live up to our agreements. So basically, that that's, you know, that's one of the things that I share with the suppliers and you know, group settings, you know, just say, you've got to understand when our contracts are up, and that should be your first question is, you know, when, or if, if we just signed a three year agreement for a competing product that you want to kind of come in and do a show and tell on unless there's a good reason to make a change or break that contract, come back to me in a year. Come back to me in two years. You know, depending on how long it takes to really kind of do the trial and go through our processes. We tried to keep everything within six to nine months process. And so I usually say you know, we're within a year of a contract expiration, we'll take a look at a product. We'll start that process, and we'll evaluate it to see what really makes sense. But those decisions generally are clear. Clinical days, and it really depends on what's going on within the hospital. You know, there's there's a lot of things that compete for the time and attention of our clinicians. And so we've got to be able to say, Hey, we can't change five major product lines for the O r in one year, it's just not attainable. And so you've got to kind of stagger those things, you've got to understand what's going on within those departments? And what is their bandwidth to really kind of do a trial and evaluation? versus Is this really a product? That's a tweak? Or is it a product that really is life changing? You know, and so, again, all of that goes into the discussion. I know, I described supply chain is pretty simple, early on, you know, you buy product, you store it, you sell it, but you're getting a handle, you're getting an idea of you know, how complex it really is
Patrick Kothe 55:51
complex and political and political. Yeah, so let's talk a little bit about the value analysis committee, because a lot of these products end up there to to really ascertain whether they're providing good clinical benefits, and if if the cost benefit is is worth it. So what happens at at a value analysis committee meeting, what what types of things are being evaluated? And what's good practice for a company that's coming in with with a product and putting that in front of a value value analysis committee?
Mike Langlois 56:26
Yeah, I think, you know, so our value analysis committee at Boma, we never allowed any suppliers to present there, we would, you know, we would manage that ourself, the agenda was generally driven by our contract contracting periods, you know, again, we would start a year to 15 to 2024 months in advance, depending on the complexity of the contract, and what are the product line what we're trying to do, but get an understanding what that that timing is by the suppliers is really important. Coming in bringing that product, that new product or understanding what the process is, is really, really critical to and that all starts and stops with supply chain. But once that happens, then again, our agenda is really driven by Okay, and then an 18 months are given the contract is going to be expiring, we've got to start thinking about what the strategy is, you know that we currently are down to three suppliers, we're going to get trying to get down to two. And we provide all that data, what the uses data is to that group, and say, here's kind of what it is, here's what we think it means to renegotiate a contract with our three suppliers. Here's what it means to probably put it out to bid. Here's what it might mean to go down to two suppliers, again, market research. If your volume is equally divided amongst three suppliers, it's a lot different than if 45% is with 140 5% is with two and 10% is with the third, you know, you may be able to get down to two suppliers at that point. So I think, again, that market research, what's going on in the industry as a whole what's going on within your organization, is really important data to bring forward to the team. And and and the suppliers can provide some of that as well, they can provide what's going on within the health, you know, they can basically say, we've got 50% of the market share. And you know, we're not under contract, and we really think you should, you know, kind of evaluate us and our market share is actually going up, it's not going down. And so those are some of the things that are really, really important for us to try to understand. You know, as well as obviously, the the baseline pricing, and where do they think they could be from a pricing standpoint? And then again, total cost of healthcare, is that a really affecting patient outcomes? That's that's really, really critical in today's today's world.
Patrick Kothe 58:47
Like, what do you think that companies don't understand about supply chain that that they need to understand?
Mike Langlois 58:55
I mean, there's a lot of things that within the organization, they just don't know. And again, I talked about competing priorities, it may seem like a no brainer that, hey, here's a product I got 60% of the market share. I'm less expensive. You know, what, why would you not consider changing today? Well, we're under contract, we're under contract for another three years. We're not going to make that change. We're going through an IV pump change, which is the most significant change that I think you can go through the hospital why we're not going to go through a IV needles change on the backup. So it's those competing things that they just don't understand. There's a major robotics company that pretty much had the I had the corner on the market, their sales managers were having a meeting in Atlanta, I went talk to them. They were pretty confident that you know, hey, we got the corn on the market. There's nobody that's doing it. The doctors all want it. And you know, I just shared with them. You may think you got the corner on the market but your competition isn't other robotic companies, but it is every MRI. It is every lab piece of equipment in your company. For a very limited cap, capital equipment fund, it may make sense, you could do a value prop that says, hey, you know, this is going to provide a million dollars of added revenue to your bottom line, if you buy this product, and this, this volume of business comes your way. But there are competing pieces of capital equipment that are gonna bring two or $3 million, and you can't just do them all, you just don't have the funds to do them all. So I think there's, they're in their own world, they believe that they have the best product, they believe they have the best price, but they don't understand what's going on on the other side of the of the equation. And again, I'm happy I always try to share that with them, I always try to share kind of where we're at. And you know, be open and honest, listen, their contract, we're under contract for another three years, or, you know, we're under contract for a year, but we're going to extend that contract for another 18 months, because we can't handle, you know, a product change of this magnitude in the next 18 months. And so the more that you provide them that information, the more they ask versus just come in and say, I got a great value prop, you should really look at my product, it probably doesn't make sense to them, but certainly information that they need to have.
Patrick Kothe 1:01:11
You mentioned earlier that there are some companies that you've done business with for a long time, and you've got great relationships with and you consider them to be good partners? And what are the things that they do to make them good partners,
Mike Langlois 1:01:27
and they understand our business? I mean, you know, they they're not coming in trying to just say, Hey, can you buy this from me? They're trying to understand what our challenges, what are our complexities? What is the timing of things? What does it take really to kind of get business from us? And how could they help? What are our strategies? You know, is it you know, to, again, reduce mortality? Do they have a product that can help us reduce mortality? Do they have a product that can shorten length of stay? Do they have a product that can shorten the clinicians time and caring for a particular patient? You want those suppliers to come in educated about the organization? I don't want a supplier coming in and asked me, How many hospitals do you have? And what GPO do you belong to? Don't take up my time with those basic questions. Let's talk strategy. Let's talk about where you know, our our gaps are. Let's talk about you know how you can help with the with our goals and objectives. Don't ask me how many hospitals we have? You can find that on the internet?
Patrick Kothe 1:02:31
What's in it for me versus what's in it for you?
Mike Langlois 1:02:33
Exactly?
Patrick Kothe 1:02:36
Well, Mike, this has really been a great conversation, I really appreciate the insights that you provided, do you have a final message that you'd like to deliver to people that work within industry within the medical device industry,
Mike Langlois 1:02:51
also one important, very, very important thing to remember. And this, this has been told to me a number of times, and I have to keep reminding myself that, you know, we in supply chain, we in the supplier community, we in the GPO community, very rarely see a patient. But everything that we do is so critical to helping that clinician care for our patients. And so the importance of our jobs, the importance of what we do, you know, trying to save another dollar isn't just trying to improve our bottom line is trying to free up another dollar for a piece of capital equipment that will save a life. And so I think the importance of what we do is is really critical. We I was fortunate enough to be in front of a medal of honor winner not too long ago, now a 29 year old but at the time, a 21 year old Marina jumped on a grenade, and went through three years of rehab, I mean, lost and I and II, he was severely severely injured. At the end of that conversation or that presentation to us and just telling his story. He stopped and thanked all of us, he says because if it wasn't for all of you, I probably wouldn't be here today. Because everything that I did needed supplies needed services, needed help. And he says I was able to thank the caregivers that were with me every day in the hospital and take care of me. But now I get a chance to thank all of you behind the scenes, because you were as important in getting the critical supplies and the services to me to really help me recover from you know, was a devastating injury. And so, so again, I think, you know, and this isn't a unique story, it's it's something that I've heard a number of times, and I've tried always, you know, when I had staff, you remind them to is that we don't really interact with patients on a day to day basis, but we're really, really critical and making sure that those patients are cared for and are able to recover from whatever injuries or diseases or even giving birth a happy occasion giving birth, our work and our support is really, really critical to that And we should never kind of lose sight of that.
Patrick Kothe 1:05:04
There was so much good advice from Mike, about what it takes to have a good buyer seller relationship, a few of my takeaways, first, integrity, and its integrity of people and companies. The first thing is, do you know what your reputation is? They get all of us have a have an idea what our own personal reputation is, but what is your company's reputation? How does that affect how your ability to do business with somebody? How do you understand that? And how do you get it back if somebody blew it for you? Also, as far as integrity goes, I mean, it's all basics. Be honest, do what you say you're going to do. Don't go around somebody back. These are things that that our parents taught us way back when, and and also understand you won't always win this time. But if you do things wrong, you're never going to win. The second thing is, understand what their strategies and objectives are. I thought that Mike really hit that one. Well, it's not about what you can find out on Google. It's what are they specifically working on right now? And then, once you understand that, how can you help them? Not how they can help you, but how can you help them achieve those objectives. And if your product supports one of those things, you're absolutely going to be well received from that group, and have a really good chance to get in the business. The last thing is timing. Not only when contracts are up, but also keeping them informed when you've got upcoming products or new technologies, if possible. Now, we've got our own strategic reasons within a company why we may or may not want that that information out. There's also FDA regulations that prevent us from pre marketing a product. But there are instances where we can talk about clinical trials that are underway are different projects that are known within the marketplace, that we can make people aware that these are coming. Again, not pre marketing, not doing anything from a strategic standpoint within your company, that that's going to compromise, compromise you and then trying to jam a product introduction and when they have another integration going. That's not doing anybody any favors either. Even if you got it to happen and they had a major, a major introduction going on, and you're able to get in there at the same time. While you're probably not going to have their support and without their support. And with a competing project going on your your introduction may end up to be a disaster. And then if you are working with them within their timeframe, it shows them that you're a good partner that you understand and that you care. Thank you for listening. Make sure you get episodes downloaded to your device automatically by liking or subscribing to the mastering medical device podcasts and Apple podcasts, Spotify, or wherever you get your podcasts. Also, please spread the word and tell a friend or two to listen to the mastering medical device podcast. As interviews like today's can help you become a more effective medical device leader. Work hard. Be kind
