The document discusses supply chain optimization opportunities for Medical Technologies Corporation to offset costs from the Affordable Care Act excise tax. Short term opportunities include changing the sales representative model. Mid-range opportunities involve optimizing distribution channels and the third-party logistics partners. Long term opportunities include adding smart kiosks and acquisitions. The proposed changes aim to reduce costs through streamlining logistics and transitioning from direct sales to increase visibility and reduce variability and costs. Risks include moving from the distributor model.