Supply Chain Resilience Measurement | HHS 2025 Guide

Why Supply Chain Resilience Measurement Matters Now

Supply chain resilience has emerged as one of the most pressing challenges in modern healthcare delivery. When Hurricane Helene devastated manufacturing facilities in late 2024, hospitals across the United States faced critical shortages of intravenous saline solution — a product so fundamental to medical care that its absence threatened patient outcomes on a national scale. This was not an isolated incident but rather the latest in a growing pattern of medical product supply chain disruptions that have exposed deep structural vulnerabilities in how essential healthcare supplies reach patients.

The U.S. Department of Health and Human Services, through its Office of the Assistant Secretary for Planning and Evaluation (ASPE), released a landmark report in September 2025 titled Defining and Measuring the Resilience, Criticality, and Vulnerability of Medical Product Supply Chains. Prepared by Mathematica, this report synthesizes expert perspectives from academia, industry, and government to establish shared definitions and measurement approaches for supply chain resilience. Understanding this framework is essential for healthcare leaders, policymakers, and supply chain professionals seeking to build more robust systems.

The report arrives at a critical juncture. Federal and private-sector leaders increasingly recognize the importance of building supply chain resilience, yet they lack the shared definitions and measurement tools needed to guide investments, oversight, and preparedness. Without a common language and standardized metrics, efforts to strengthen medical product supply chains remain fragmented and difficult to evaluate. The ASPE framework provides the conceptual foundation needed to align these efforts across sectors.

Defining Supply Chain Resilience in Medical Products

Supply chain resilience measurement begins with a clear definition. According to the HHS ASPE report, resilience refers to the ability of a supply chain to anticipate, prepare for, respond to, and recover from disruptions while maintaining continuous function. This definition builds on established academic literature, notably the work of Pettit, Fiksel, and Croxton (2010), who conceptualized resilience as the interplay between vulnerabilities and capabilities within a supply chain system.

The ASPE framework identifies several core capabilities that characterize resilient supply chains. These include visibility — the ability to map and monitor supply chain nodes in real time; flexibility — the capacity to shift production, sourcing, or distribution in response to disruptions; collaboration — cross-sector coordination among manufacturers, distributors, healthcare providers, and regulators; and agility — the speed with which a supply chain can adapt to changing conditions.

Beyond capabilities, the framework distinguishes between enablers and outcomes of resilience. Enablers include organizational culture, information-sharing infrastructure, regulatory frameworks, and financial resources that support resilient behaviors. Outcomes are measured by the supply chain’s ability to maintain product availability, minimize disruption duration, and return to baseline performance levels after a shock event. This multi-layered approach recognizes that supply chain resilience is not a single metric but a complex system property that requires assessment across multiple dimensions.

The report emphasizes that resilience is distinct from efficiency. In fact, many of the practices that maximize supply chain efficiency — such as just-in-time inventory, single-source procurement, and geographic concentration of manufacturing — actually undermine resilience by reducing buffers and increasing vulnerability to disruption. This tension between efficiency and resilience is a central challenge for organizations seeking to optimize their supply chain strategies.

The HHS ASPE 2025 Framework Explained

The HHS ASPE 2025 framework establishes a structured approach to understanding and measuring supply chain resilience through three interconnected concepts: resilience, criticality, and vulnerability. Each concept addresses a different dimension of supply chain risk and together they provide a comprehensive lens for assessment and decision-making.

Resilience operates at the supply chain system level and addresses the overall capacity to withstand and recover from disruptions. Criticality operates at the product level and addresses which medical products are most essential to patient care and public health. Vulnerability also operates at the product level but focuses on which supply chains are most susceptible to disruption based on structural characteristics like geographic concentration, supplier diversity, and manufacturing complexity.

The interplay between these three concepts is crucial. A highly critical product with a highly vulnerable supply chain represents the greatest risk to patient safety and requires the most urgent attention. Conversely, a product that is critical but not particularly vulnerable may need less immediate intervention. The framework thus enables risk stratification and resource prioritization — essential functions for federal agencies and healthcare organizations operating with limited budgets and competing demands.

The report draws on an environmental scan of recent literature, federal reports, and measurement tools, combined with eight key informant interviews and a technical expert panel (TEP) representing academia, industry, and government. This multi-method approach ensures that the framework reflects both theoretical rigor and practical experience from stakeholders across the medical product ecosystem. As noted by the ASPE policy brief on drug shortages, aligning these perspectives is essential for effective policy implementation.

Supply Chain Criticality: Identifying Essential Products

Supply chain criticality addresses a fundamental question: which medical products are most essential to maintain in uninterrupted supply? The ASPE framework identifies criticality as a product-level assessment that considers clinical importance, patient population impact, and the availability of therapeutic alternatives.

The report catalogs several existing approaches to defining critical medical products. The FDA maintains lists of essential medicines and has developed criteria for identifying products whose shortage would pose the greatest risk to patient health. The World Health Organization’s Essential Medicines List provides an international benchmark, while the U.S. Pharmacopeia (USP) has developed its own classification system. The Department of Defense maintains a separate essential medicines list tailored to military healthcare needs.

Key factors in determining criticality include the severity of clinical consequences if the product becomes unavailable, the size and vulnerability of the affected patient population, the availability and clinical equivalence of substitute products, the product’s role in emergency and critical care settings, and the product’s importance to national security and public health preparedness. The report notes that different stakeholders may weight these factors differently — a hospital system may prioritize products used in its highest-volume procedures, while a federal agency may focus on products essential during pandemic response.

One significant finding from the expert panel is that criticality is not static. A product’s criticality can shift based on epidemiological conditions, the emergence of new therapeutic alternatives, changes in clinical practice guidelines, and evolving public health threats. This dynamic nature means that criticality assessments must be regularly updated rather than treated as fixed classifications. The USP Medicine Supply Map represents one tool that enables ongoing monitoring of product-level supply chain characteristics.

Measuring Supply Chain Vulnerability

Supply chain vulnerability measurement focuses on identifying structural weaknesses that make specific product supply chains susceptible to disruption. The HHS ASPE framework introduces a particularly useful conceptual tool: the distinction between potentiators and buffers.

Potentiators are factors that increase a supply chain’s susceptibility to disruption. Key potentiators identified in the report include geographic concentration of manufacturing, where a small number of facilities or regions account for a disproportionate share of production; limited supplier diversification, where few manufacturers produce a given product; long and complex supply chain pathways that create multiple points of potential failure; reliance on single-source raw materials or active pharmaceutical ingredients; and regulatory barriers that slow the qualification of alternative suppliers.

Buffers, conversely, are factors that mitigate vulnerability and help supply chains absorb shocks. Important buffers include strategic inventory reserves held by manufacturers, distributors, or healthcare systems; qualified alternative suppliers that can increase production when primary sources are disrupted; domestic manufacturing capacity that reduces dependence on international supply lines; robust information-sharing systems that provide early warning of potential disruptions; and contractual arrangements that guarantee supply commitments during shortage conditions.

The vulnerability assessment framework recognizes that these factors interact in complex ways. A supply chain with strong potentiators (high geographic concentration, limited suppliers) may still demonstrate moderate vulnerability if it also has strong buffers (large inventory reserves, rapid qualification of alternatives). This nuanced approach moves beyond simple binary assessments of vulnerable versus secure and enables more granular risk quantification.

The report highlights that over half of active pharmaceutical ingredients (APIs) for prescription medicines in the United States originate from India and the European Union, according to USP data. This geographic concentration represents a significant systemic potentiator, as disruptions in these regions — whether from natural disasters, geopolitical conflicts, or regulatory actions — can cascade across the entire U.S. pharmaceutical supply chain.

Data Sources and Measurement Tools for Supply Chain Resilience

Effective supply chain resilience measurement depends on reliable data sources and validated measurement tools. The ASPE report provides a comprehensive inventory of existing resources while identifying critical gaps that limit current measurement capabilities.

Federal data sources include the FDA Drug Shortage Database, which tracks active and resolved shortages and their causes; the Census Bureau trade data, which provides information on import volumes and country of origin for pharmaceutical and medical device products; and various HHS and ASPE reports that analyze shortage trends, policy interventions, and supply chain vulnerabilities. The GAO’s 2025 report on drug shortages further documents coordination challenges across federal agencies.

Private-sector tools include Resilinc’s Disruption Vulnerability Index (DVI), which uses artificial intelligence and real-time monitoring to predict supplier risk exposure; the SMI Resilience Maturity Model Scorecard, which allows organizations to assess their supply chain resilience across multiple dimensions; and the USP Medicine Supply Map, which provides product-level supply chain intelligence including API sourcing, manufacturing locations, and supplier concentration metrics.

Academic frameworks complement these practical tools. The report references the work of Piffari, Lagorio, and Pinto (2024) on resilience indicator classification for healthcare supply chains, as well as Yang and Zelbest’s (2024) framework for crisis management readiness assessment. These academic contributions provide theoretical grounding for the more applied measurement approaches used by industry and government.

Despite this growing ecosystem of tools and data sources, the ASPE report identifies significant gaps. End-to-end supply chain mapping remains incomplete for most medical products. Real-time visibility into inventory levels across the supply chain is limited. Data on sub-tier suppliers — the companies that supply raw materials and components to primary manufacturers — is especially scarce. And there is no standardized, universally adopted framework that integrates resilience, criticality, and vulnerability measurements into a single comprehensive assessment. Organizations looking to transform complex data into actionable insights face ongoing challenges in bridging these gaps.

Key Challenges in Measuring Supply Chain Resilience

Measuring supply chain resilience presents several persistent challenges that the ASPE report documents with input from experts across sectors. Understanding these challenges is essential for organizations attempting to implement resilience measurement programs and for policymakers designing interventions.

The first major challenge is data fragmentation. Supply chain data is distributed across multiple public and private entities, each with different reporting standards, timelines, and access restrictions. FDA shortage data captures only products that meet specific reporting thresholds. Trade data from the Census Bureau provides aggregate volumes but lacks product-level granularity for many medical supplies. Private-sector data from companies like Resilinc and Vizient offers greater depth but is proprietary and not universally accessible. This fragmentation makes it difficult to construct a comprehensive picture of supply chain health for any given product category.

The second challenge is measurement complexity. Supply chain resilience is an emergent property of a complex system, not a directly observable characteristic. It manifests only when a disruption occurs, making prospective measurement inherently difficult. Proxy metrics — such as supplier count, geographic diversification, and inventory levels — can indicate potential resilience but cannot guarantee actual resilient performance during a crisis. The report notes that experts disagreed on whether resilience should be measured as a static capability (readiness) or a dynamic outcome (actual performance during disruption).

A third challenge is proprietary barriers. Much of the most valuable supply chain data is held by private companies that consider it competitively sensitive. Manufacturers may be reluctant to disclose supplier relationships, inventory levels, or production capacity details. This creates a tension between the public interest in supply chain transparency and the private interest in protecting commercial information. Several expert panelists suggested that regulatory mandates or incentive structures may be needed to overcome these barriers while protecting legitimate commercial interests.

The fourth challenge involves dynamic conditions. Supply chains are constantly evolving in response to market forces, regulatory changes, technological innovation, and geopolitical shifts. A resilience assessment conducted today may not reflect conditions six months from now. This dynamic nature requires continuous monitoring rather than periodic assessment, yet the infrastructure for real-time supply chain surveillance remains underdeveloped for medical products compared to other sectors like automotive or consumer electronics manufacturing.

Building Supply Chain Resilience: Strategies from ASPE

The HHS ASPE report does not merely diagnose problems — it also identifies strategies for building supply chain resilience based on expert consensus and emerging best practices. These strategies operate at multiple levels, from individual organizations to federal policy frameworks.

At the organizational level, the report recommends that healthcare systems and manufacturers invest in supply chain visibility. This means mapping not just direct suppliers but also sub-tier suppliers who provide raw materials and components. Tools like the USP Medicine Supply Map and Resilinc’s platform can support this mapping, but organizations must also invest in internal capabilities to analyze and act on supply chain intelligence.

Supplier diversification emerges as a critical resilience strategy across all expert perspectives. Relying on a single supplier or a small number of geographically concentrated suppliers creates unacceptable concentration risk. The report recommends that organizations develop and maintain relationships with qualified alternative suppliers, even when primary suppliers are performing well. This proactive approach enables faster switching during disruptions, reducing the duration and severity of supply chain impacts.

Strategic inventory management represents another key lever. While just-in-time inventory practices minimize carrying costs, they also eliminate the buffers needed to absorb supply shocks. The report suggests that organizations adopt a risk-stratified approach to inventory management, maintaining larger reserves for critical and vulnerable products while optimizing inventory levels for lower-risk items. The National Academies of Sciences, Engineering, and Medicine’s 2022 report on building resilience into medical product supply chains provides additional guidance on inventory strategies.

Cross-sector collaboration is identified as essential. The Healthcare Industry Resilience Collaborative (HIRC) and similar organizations facilitate information sharing and coordinated response among supply chain stakeholders. The report emphasizes that resilience cannot be achieved by individual actors working in isolation — it requires a network-level approach that aligns incentives and information flows across manufacturers, distributors, group purchasing organizations, healthcare providers, and regulators.

Finally, the report advocates for investment in domestic manufacturing capacity to reduce dependence on international supply lines for critical products. While this strategy involves significant capital investment and may increase production costs, it provides a geographic diversification buffer against disruptions in overseas manufacturing regions. Several federal programs, including initiatives from the Department of Commerce, are already supporting this direction with funding and incentive structures.

Policy Implications for Healthcare Supply Chains

The ASPE framework carries significant implications for federal policy on medical product supply chain management. The report identifies several areas where policy action could strengthen resilience measurement and build more robust supply chains for essential medical products.

Standardization of definitions is a foundational need. Without agreed-upon definitions of resilience, criticality, and vulnerability, federal agencies, industry actors, and healthcare organizations cannot align their efforts or measure progress consistently. The ASPE framework provides a starting point, but formal adoption across federal agencies — including FDA, HHS, Commerce, and DHS — is needed to establish a common lexicon.

Data sharing mandates and incentives could address the proprietary barriers that limit supply chain visibility. The report suggests exploring regulatory requirements for manufacturers to report supply chain risk indicators, similar to existing shortage reporting requirements but broader in scope. Alternatively, voluntary data-sharing frameworks with appropriate confidentiality protections could encourage greater transparency without imposing compliance burdens on smaller manufacturers.

Federal coordination is essential. The GAO’s 2025 report documented that multiple federal agencies have overlapping responsibilities for medical product supply chain management, yet lack a formal coordination mechanism. The ASPE framework could serve as a basis for inter-agency alignment, with each agency contributing data and expertise within its domain while working toward shared measurement standards and resilience objectives.

The U.S. Senate Committee on Finance has already taken legislative action, with Senators Wyden and Crapo releasing draft legislation to combat prescription drug shortages. The ASPE measurement framework could inform implementation of such legislation by providing evidence-based criteria for identifying at-risk products and evaluating the effectiveness of interventions.

Investment in measurement infrastructure is also recommended. The report calls for development of integrated dashboards and early warning systems that combine data from multiple sources to provide real-time supply chain intelligence. Such infrastructure would enable proactive rather than reactive management of supply chain risks, potentially preventing shortages before they impact patients. Several digital transformation initiatives in healthcare are laying the groundwork for this kind of data infrastructure.

Future of Supply Chain Resilience Measurement

The HHS ASPE 2025 framework represents a significant step forward in supply chain resilience measurement, but it also points toward an evolving landscape of tools, standards, and capabilities that will shape the future of supply chain management in healthcare.

Artificial intelligence and predictive analytics are poised to transform resilience measurement. Tools like Resilinc’s Disruption Vulnerability Index already use AI to predict supplier risk exposure based on real-time monitoring of global events. As these technologies mature, they will enable more sophisticated early warning systems that can detect emerging risks before they materialize as supply disruptions. Machine learning models trained on historical shortage data could identify patterns and predict which products are most likely to experience future disruptions.

Blockchain and distributed ledger technologies offer the potential for end-to-end supply chain traceability, creating immutable records of product provenance and chain of custody. While adoption in pharmaceutical supply chains has been slow, the Drug Supply Chain Security Act (DSCSA) is driving investment in electronic tracking systems that could eventually support more comprehensive supply chain mapping and real-time visibility.

International harmonization of resilience standards is another frontier. Organizations like the World Health Organization, the European Medicines Agency, and the International Society for Pharmaceutical Engineering are developing their own frameworks for supply chain resilience. Aligning these international frameworks with the ASPE approach could enable global supply chain risk assessment and coordinated response to cross-border disruptions.

The report also anticipates growing integration of environmental and climate risk into supply chain resilience assessment. As climate change increases the frequency and severity of natural disasters — as demonstrated by Hurricane Helene’s impact on IV saline production — supply chain models will need to incorporate climate projections and geographic vulnerability assessments into their risk calculations. This intersection of climate adaptation and supply chain management represents a rapidly evolving area of practice and research.

Finally, the democratization of supply chain intelligence through accessible platforms and interactive tools will enable a broader range of stakeholders to participate in resilience building. Healthcare systems, community health centers, and smaller manufacturers that currently lack the resources for sophisticated supply chain analysis may gain access to affordable tools that provide actionable risk information. Making complex supply chain data accessible and engaging for diverse audiences will be critical to this democratization effort.