CASE MEDICAL INTRODUCES:

CASE SOLUTIONS FOR NOVAPLUS PRIVATE LABEL

NOVAPLUS

Market Dynamics Affecting the Provider Community

The Playing Field

MARKET DYNAMICS – PROVIDER PERSPECTIVE

Source: Healthcare Financial Management Association (February 2010)3

Reducing Supply Costs is the Top Focus of Most Hospital Executives

THE NEW NORMAL

Provider consolidationSupplier consolidation Continued cost pressuresLower-cost delivery of

care - non-acute shiftNew cost-quality

considerationsLess physician controlMore complex

interactions

Higher Expectations for Savings and Service

Increased Competitive Activity; Gravitation to the GPO Partner Who Provides Clear recommendations

for cost reduction Seamless integration of

data, intelligence and tools

Expertise to implement strategic cost improvements

Solutions across the care continuum

Potential Consequences

Implications

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Health Care Reform Features

NOVATION: THE HIGHEST-SCORING PLAYERSNine out of ten “Best Hospitals” use Novation

These “nine” should be targets.

12

35

67

89

10 (Tie)

Johns Hopkins Hospital Baltimore Mayo Clinic

RochesterMassachusetts General

Boston Ronald ReganUCLA Medical Center

Los Angeles

New York Presbyterian Hospital of Columbia

and CornellUniversity of California

San Francisco Medical Center

Barnes Jewish Hospital/Washington

Univ., St. LouisHospital of the Univ.

of Pennsylvania Philadelphia

Duke University Medical Center

Durham, NC

VHA UHC Provista

Membership •1,400+ Hospitals•30,000+ Non-Acute

• 111 Academic Medical Centers

• 220 Affiliated Hospitals

• 1,011 Hospitals• 13,454 Non-Acute • 3,360 Colleges,

Universities and Schools

Field Support

• 95 Account Executives

• Covering 16 Offices

• 20 Account Executives

• 30 Account Executives

MEMBERSHIP AND FIELD SUPPORT

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Note: NOVAPLUS administration and field sales force are supporting Case Medical.

NOVAPLUS helps customers achieve standardization by offering low cost, high-quality, medical, surgical and pharmaceutical products with favorable marketplace pricing. 

NOVAPLUS supply partners are carefully selected and are consistently evaluated through a rigorous quality assurance process. Quality that customers can trust.

The line will be available beginning January 1st

STANDARDIZATION:DRIVING COMMITMENT THROUGH PRODUCT STANDARDIZATION

More than 3,000 participating members. Goal: Reduce variation for non-clinically preferred

products while increasing ordering efficiencies. Customer must commit to 90% of all spend in the

category to receive rebates. Customer must provide a signed commitment. Commitment level is monitored on a quarterly

basis. Case Medical shares the Standardization program

for instrument chemistries with Ecolab and Steris.

NOVATION STANDARDIZATION PROGRAM

Provides rebates to members that standardize on non-clinically preferred products Overall program rebates average 3%-6% 100% rebate/value flows back to member

Programs available Anesthesia Bedside Care Food Service General Surgery Infection Control Medical II Medical IV NOVAPLUS Pharmaceuticals Orthopedic Respiratory

Program Features Participation is voluntary Many categories have choice of suppliers On line reports detailing performance

STANDARDIZATION:DRIVING COMMITMENT THROUGH PRODUCT STANDARDIZATION

Standardization

NOVAPLUS, Novation's private-label brand delivers the best financial value and quality on the commodity products organizations use most often. With more than 1,800 individual line items in more than 50 product categories.

NOVAPLUS:BETTER PRICES. BIGGER POSSIBILITIES.

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Lowest market price on the most frequently-purchased commodity products 40 non-pharmacy product categories 92 pharmacy product categories

17% average savings

NOVAPLUS:DRIVING COMMITMENT THROUGH PRICE LEADERSHIP

NOVAPLUS

NOVAPLUS/Pitt Plastics Can Liners

DRIVING COMMITMENT THROUGH NOVAPLUS: CASE STUDY

• Conversion rate of 85%-90% from previous supplier

• As a certified diversity supplier, Pitt Plastics helps members reach their diversity goals

• Growth within NOVAPLUS has helped Pitt Plastics achieve growth

“If you want a position in the health care arena, then NOVAPLUS is absolutely where you want to be.”

--Matt O’Doherty, Vice President, Sales

From Zero Market Position to Market Share Leader

NOVAPLUS

DRIVING COMMITMENT THROUGH NOVAPLUS: CASE STUDY

“I have personal experience in leveraging the NOVAPLUS opportunity growing a business ten-fold and capturing 90% market share.”

--John Penhollow, Director of Corporate Accounts Case Medical

“Case Medical’s opportunity is $6.5 million for this category.”

--Scott Holbrook, Contract Manager Novation

From Zero Market Position to Market Share Leader

NOVAPLUS

John Penhollow’s Story

There are more than 20 VHA SupplyNetworks nationally 94% of all supply network agreements originate from the Novation portfolio 62% of VHA shareholders and partners participate in a VHA SupplyNetwork

VHA SUPPLYNETWORKSAggregation

We offer lower prices for NOVAPLUS than our branded products

Novation provides marketing, support from their field sales team, and committed customers

Provides rebates to members that standardize on non-clinically preferred products Overall program rebates average 3%-6% 100% rebate/value flows back to member

NOVAPLUS MEDICAL INSTRUMENT CLEANERSSALES AND MARKETING PROMOTION

Standardization

NOVAPLUS provides us with a sole source, private label product line at a reduced cost for their membership

An additional product line, not a replacement for our Case Solutions or SuperNova instrument cleaners

In fact, we are competing against ourselves, which is an excellent place to be! Furthermore, they can still buy SuperNova and Case Solutions.

We offer lower prices with rebates for NOVAPLUS Novation provides marketing, support from their field sales team,

and committed customers Easy as can be.

We introduce only 8 SKU’s, in most cases derivatives of the same products in one gallon or 2.5 gallon totes

Ideal for standardization. A simpler, less concentrated version of SuperNova with the same

credentials.

NOVAPLUS:BETTER PRICES, BIGGER POSSIBILITIES

HISTORY OF NOVAPLUS

The private label of VHA, UHC and Provista began as VHAPLUS in 1985.  The “PLUS” continues to stand for: Prices Lowered Utilizing Standardization.

In 1998, the brand became NOVAPLUS and has since grown to include high quality products in more than 150 categories representing nearly 1,800 SKUs.

All NOVAPLUS products are identical to their brand-name equivalents.

Our friend and consultant John Burks started NOVAPLUS.

NOVAPLUS ENHANCEMENT Case Medical has received the sole source

NOVAPLUS contract commencing Jan. 1, 2013.

Contract Enhancements through Novation The newly awarded NOVAPLUS private label

contract for 8 SKU’s NOVAPLUS is the exclusive private label of

Novation (VHA, UHC, Provista) NOVAPLUS delivers a financial value on the

most frequently purchased health care commodity products.

NOVAPLUS Product Offering A full line of surgical instrument cleaners for each

step in the cleaning process. Products for pre-cleaning and soaking, manual and

automated cleaning. A line of synergistic cleaners with compatible

chemicals similar to our SuperNova system, but less complicated and less concentrated.

Focus: Acute Care Hospitals, Surgery Centers, Physicians Offices, Clinics, and the Endo Lab.

READY TO USE ENZYMATIC PRE-CLEANERS

NPE024 24 oz. / 12 per case

NPE054 1 gallon / 4 per case

MULTI-ENZYMATIC CONCENTRATE

NPC055 2.5 gallon / 2 per case

NPC054 1 gallon / 4 per case

NEUTRAL PH DETERGENT CONCENTRATE

NPB055 2.5 gallon / 2 per case

NPB054 1 gallon / 4 per case

LUBRICANT CONCENTRATE

NPL055 2.5 gallon / 2 per case

NPL054 1 gallon / 4 per case

WHY CASE MEDICAL? Full line of products:

Super concentrated and ready-to-use cleaners for each step in the decontamination process including pre cleaners, super concentrated cleaners for manual and automated cleaning

Cost savings and compatibility Pennies on the dollar when analyzed at use dilution pH neutral and compatible with all medical devices

protecting your investment and reducing the cost associated with replacing rusted and pitted instruments

Packaged in 2.5 and 1 gallon bottles to maximize inventory space, eliminate ergonomic and handling issues and save on shipping costs

Ease of use and product assurance Environmentally-friendly, water-soluble, liquid cleaners

with no added dyes, fragrances, fillers or masking agents Proven effectiveness with validated products and process Sealed automated dispensing with dose control and flow

control to avoid over or underuse

BREAKING THE MYTH

University study results proved that our pH neutral cleaners are as effective or more so than an alkaline version of the same product.

Advantages: Non- corrosive, safe for people and the environment

Major cost savings Extends the useful life of devices Avoids the need for a neutralizing step.

The EPA has awarded us with a preferred partnership under their Design for the Environment program for our “Green” Instrument Chemistries.

This awarded partnership means that Case Medical’s SuperNova and Case Solutions instrument cleaners contain only the safest ingredients among chemicals in their class and adhere to a set of practices designed for the environment.

We are sharing this certification with NOVAPLUS products.

QUALITY CERTIFICATIONS

Look for this logo

The need for instrument and scope cleaning chemicals (except machine proprietary chemicals) that can be used for both the clinic setting and the hospital setting.

o Case Medical can provide 100% of all instrument and scope cleaning chemicals.

o Our enzymatic cleaners are provided ready to use as well as concentrated for automated machines.  

o The same products was developed for soaking and manual cleaning at ready to use dilution.

o High concentrations of 5+ synergistic enzymes with material compatibility are provided for pre-cleaning and washing of instruments and scopes.

ADDRESSING THE NEEDS

ADDRESSING THE NEEDS

A step by step chemistries program that can be implemented across the system to process all instruments.

o Case Medical will collaborate with your system to assess the needs of each facility.

o We will review the water quality, temperature and machine settings and provide recommendations for a consistent, standardized outcome.

o Case Medical provides synergistic cleaners for each step in the decontamination process.

o We will provide a step by step program for both manual and automated cleaning for your system.

 

An education program to train all staff members on instrument processing.

o Case Medical offers both onsite and online education to train staff on the products and process.  

o We provide color coded info sheets that can be posted as well as color coded labels and hoses for ease of use.

ADDRESSING THE NEEDS

o Case Medical chemicals do not require special ventilation as they are non-toxic, hypoallergenic at use dilution.

o We provide sealed dispensing to reduce errors from handling or misuse.

o As with any cleaners for health care, PPE is required.  

o Our products are clearly labeled with any cautions or warnings.

ADDRESSING THE NEEDS

WHY WE ARE THE RIGHT FIT

Our products can be used in every step of the decontamination process: pre-cleaning, soaking, manual cleaning, sonic, automated washers, and cart washers and are ideal for reprocessing instrumentation in the endo lab.

We provide education through on-site instruction, as well as our online Case Academy and ongoing webinars with CEUs.

We can do a full needs assessment including water quality analysis and identify / implement cost effective steps for optimal outcome.

WHY pH NEUTRAL?

According to AORN recommended practices, “Neutral detergents with a pH of 7, that are low foaming, and free-rinsing, should be used for manual and mechanical cleaning of surgical instruments and equipment.”

“Neutral pH detergents work well when enzymatic solutions are used as a part of the cleaning regimen.”

Case Solutions and Supernova chemistries as well as the NOVAPLUS products are pH neutral low foaming and free rinsing.

KEY CALL POINTS

Materials Management Surgical Services Executives Sterile Processing ASC Director/Manager Nursing/Operating Room GI/Endo Labs Physician’s Offices

SUPPLIER INSIGHT

Case Medical is a diversity supplier (woman-owned)

Case Medical is the only contracted supplier for this category that has EPA/DfE certification. This means that Case Medical’s instrument chemistries have been thoroughly verified for sustainability and contain only those ingredients that are the least harmful to the environment.

Case Medical ascribes to the overkill principle and has validated products and process in independent university studies.

OVERCOMING OBJECTIONS

OBJECTION: I CANNOT CONVERT TO THE NOVAPLUS/CASE MEDICAL PRODUCTS BECAUSE IT WILL VOID THE WARRANTY ON OUR MACHINES.

Response: Some of our customers have had the same misunderstanding but found when they asked their equipment rep to produce a document that tied the warranty of their machines to their use of the specific detergent there was no such stipulation. In fact, most equipment manufacturers do not manufacture their own detergent but purchase through a third party manufacturer.

OBJECTION: WE PREFER SOLID CLEANERS AS THEY ARE LIGHTER AND TAKE UP LESS SPACE

Response: Solid cleaners were originally liquid and were made solid by added binding agents, and need to be dissolved back into a liquid in order to clean. This can result in undissolved detergent residue, which may adhere to the medical devices and create patient safety issues. In addition, this residue can clog machine check valves, hoses etc which increases maintenance costs and decreases machine reliability. Furthermore, proper dilution is critical for instrument cleaners. This can be accomplished best with liquid cleaners, not solids which must be melted or dissolved.

OBJECTION: WE PREFER COMPANY X.

Response: Many of our customers found that by using Case Solutions they were able to improve patient outcome, reduce their costs and greatly simplify their supply chain.

OBJECTION: WE LIKE TO USE A WIDE RANGE OF PRODUCTS AND YOU ARE OFFERING A SYSTEM.

Our cleaners are compatible with all medicals devices including specialty instrumentation such as endoscopes. Mixing various chemicals is often unnecessary and may cause chemical reactions that can interfere with the cleaning process, create residue or may even compromise staff or patient safety. Our products and process have been validated in independent studies. Each component works synergistically and harmoniously together. Some chemical components are just not compatible with each other. We have carefully selected our ingredients and have tested them for compatibility. We eliminate the guesswork and offer you synergistic products that work on a wide range of devices, equipment and processes.

OBJECTION: ALKALINE DETERGENTS CLEAN BETTER. Response: Many of our customers found that

the system that Case Medical has developed not only handles the toughest cleaning challenges but because of the Neutral PH their devices last longer than when subjected to the harsh alkaline detergents. Alkaline chemistries and acids cause pitting, discoloration and shorten the useful life of devices. We have proven that our pH neutral detergent performs as well as or better than the same alkaline-based product. Inferior products may need to add more caustic ingredients in order to achieve a similar outcome within the same parameters. Plus, you will need to add an acid neutralizer which cost more money and time.

OBJECTION: I WANT TO BUY MY DETERGENT THROUGH MY DISTRIBUTOR.

Response: If that is something you ultimately want to do, we have existing relationships with Owens and Minor, Cardinal and some local IDNs distributors. Many of our customers prefer placing orders directly through Case Medical.

OBJECTION: IT IS HARD TO TELL IF YOUR ENZYMATIC IS IN THE SINK BECAUSE IT HAS NO COLOR AND VERY FEW SOAP SUDS. Response: There are real benefits of having a

clear view of the instruments not only to make washing easier but also to reduce the chance of sharps injuries. You will notice the solution drawing from the bottle, through the tube. When added to the water you will see some cloudiness due to micro bubbles, and then as it dissipates, it will become a crystal clear solution. The key to using our product is to have confidence in our validated studies that show a Log6 reduction in bioburden and a > 99.9% reduction in organic soil. Once you see the results of our product on the instruments, how shiny they are, you will never want to use anything else.

OBJECTION: YOUR PRODUCT HAS NO PERFUME AND WE LIKE THE FRAGRANCE OF OUR CURRENT CLEANERS. Response: Perfumes and fragrances are added to

mask the odor of dead or ineffective enzymes and microorganisms including bacteria. Fragrances actually impede you from knowing when the enzymes are no longer working or the degree of bioburden on the instrument. Furthermore, no perfumes or fragrances are regulated by EPA. Our enzymatic detergents neutralize noxious odors emitted by bacteria and other microorganisms. We only use active ingredients that facilitate the cleaning process. We do not add fragrances as they are unnecessary masking agents and do not facilitate the cleaning process, can be an irritant, an allergen or simply objectionable to some staff.

OBJECTION: OUR SUPPLIER COLOR-CODES ALL HIS DETERGENTS AND ENZYMATIC PRODUCTS SO WE KNOW WHICH ONE TO USE.

Response: The good news is that we color code our labels instead of the solutions within. The color additive to instrument chemistries may be an irritant to many people and can leave stains on instrumentation and equipment over time. Our multiple enzyme cleaners and detergents are designed and validated to be efficacious in all scenarios and with all types of medical devices.

OBJECTION: MY CURRENT LUBRICANT IS CLEAR. WHY IS YOURS MILKY?

Response: Most clear lubricants are oil based, typically made of petroleum based products. Have you noticed a rainbow on your washer walls? Using an oil based lubricant is not recommended as it causes bronzing and contributes to residue build up. Our instrument lubricant has no petroleum or oil in the formulation. It is an aqueous emulsion, both water dispersible and free rinsing.

OBJECTION: WE TRIED YOUR PRODUCT AND HAVE OCCASIONALLY NOTICED WHITE POWDER ON OUR INSTRUMENTS.

Response: Are you currently using a water softener? Occasionally we have observed white powder residue. What we learned is that when using ours or any instrument chemistries, be sure that your water softener system is properly maintained by a reputable company. We highly recommend a RO water system. Intermittent machine malfunctioning may also cause over pumping and drawing of solution. Case Solutions and NOVAPLUS instrument chemistries and lubricant are water soluble and dispersible and free rinsing.

OBJECTION: WE NOTICED THAT THE ACQUISITION PRICE OF YOUR PRODUCTS IS HIGHER THAN OUR EXISTING COMPANY.

Response: While the acquisition cost may be higher in some cases, on a cost per use basis you will see that our concentrated products provide a greater savings at a cost per use basis.

OBJECTION: WE HAVE PARTICULARLY HARD WATER AND OUR CURRENT SUPPLIER HAS RECOMMENDED THAT WE USE AN ALKALINE DETERGENT.

Response: Our instrument chemistries are effective with all water types. In fact, when our enzymatic detergent is followed by our pH neutral detergent superior sequestering activity occurs. Our detergent has high levels of chelating agents that remove hard water ions.

OBJECTION: I HAVE BEEN TOLD NOT TO USE ANY ENZYMATIC DETERGENT OR CLEANER WHEN PROCESSING EYE INSTRUMENTS BECAUSE OF TASS. Response: All surgical instruments including eye

instruments require detergent and water with the addition of mechanical action to remove organic soil. If instrument cleaners are not utilized, the task of removing soils and infectious agents become more challenging. Case recommends rinsing after each step. We recommend the use of our pH neutral detergent to follow the enzymatic cleaning step. In addition, we do not include any of the irritants and substances such as fragrances, colors or fillers. In addition, our instrument chemistries are free rinsing for thorough removal when proper rinsing is instituted.

OBJECTION: OUR NEW WASHER HAS A “FAST” CYCLE. ARE YOUR CLEANERS COMPATIBLE?

Response: We would caution you to consider the potential consequences of using a “fast” cycle when cleaning contaminated instruments. Our instrument chemistries can be utilized in all water types and cycles, but as with any other cleaner, more product will be required to compensate for the abbreviated time and reduced temperature of these fast cycles. Thorough rinsing as with any cycle, is critical.

OBJECTION: I HAVE NOTICED THAT MY TOSI TESTS ARE NOT PASSING AS THEY ONCE DID.

Response: The TOSI is a challenging indicator of machine effectiveness and outcome. It requires specific parameters for time, temperature, and instrument chemistries The TOSI as our instrument chemistries are a constant. The variables are machine models, water quality, cycle time and temperature. While the TOSI and the instrument chemistries may not have changed, the parameters of your washer may have changed. Please refer to the TOSI trouble shooting guide. Alternatively, you may choose to use a less challenging validated monitoring device.

OBJECTION:  WE ARE NOW GETTING 10 LITERS OF ULTRA CONCENTRATED CLEANERS FROM OUR EQUIPMENT SUPPLIER, WHILE YOU ARE OFFERING 5 GALLONS FOR APPROXIMATELY THE SAME PRICE. Response:  In fact, we continue to offer you

the best product at the same price.  You are actually paying more to the other vendor.  While 10 liters may sound like more product it actually equals 2.6 gallons about half as much as ours.

OBJECTION: MY CURRENT SUPPLIER INSISTS THAT HIS INSTRUMENT CHEMISTRIES ARE “GREEN”.

While many companies claim their instrument cleaning products are “green,” Case Medical/NOVAPLUS product line is the only one to have the DfE label. When you see the DfE label; on a product, it means that EPA’s scientific review team has evaluated every ingredient for potential human health and environmental effects and allowed only chemicals from the safest in their class, that meet stringent EPA criteria to be used. DfE labeled products do not contain known chemicals of potential concern, like carcinogens, reproductive or developmental toxicants and even minor product components like dyes and fragrances. DfE only accepts the safest possible ingredients and does not allow ‘watered down’ amounts of unsafe chemicals.

KEY POINTS

Validated product with DfE endorsement Same product but easier to use and easier to

sell Ideal for standardization, compatible

components and material compatibility Access to endo labs with ready to use multi-

enzymatic cleaners Marketing and sales support from Novation’s

NOVAPLUS team

ELEVATOR SPEECH

Can I have a moment of your time to introduce you to our NOVAPLUS Instrument Cleaners?

All of our instrument chemistries are environmentally preferred and validated and selected by Novation for this sole-source contract

NOVAPLUS line addresses each step in the decontamination process

Ideal for standardization Easy to use Provide significant savings and rebates With these points in mind, would you

consider trying our product?

QUESTION AND ANSWERS

Comments, please Commitments, please