Across the board, staff, and volunteer ranks, we … It is likely that more states will pursue the less restrictive approaches in the years ahead. Some may disagree with the opinions of the Forecast Panelists or the positions taken by individual chapter authors with respect to their vision of future events. An important pharmacy-specific example of a black swan relates to Hurricane Maria in September 2017, which decimated pharmaceutical manufacturing capacity in Puerto Rico, thereby creating a crisis for U.S. hospitals. This process is particularly valuable when addressing phenomena that are not well suited to quantitative predictive methods. Recent books and media attention regarding the poor quality of active pharmaceutical ingredients (APIs) and finished drugs have prompted discussions regarding the merits of incentivizing United States–based manufacturing.4–6. Establish methods for identifying patients at risk for negative outcomes due to lack of access to essential medications or exposure to substandard-quality medications. 139-143. or Pharm.D./M.H.A. It engages the entire organization. JCO Global Oncology Contact Us Without a strategic plan, leaders are forced to hastily react rather than thoughtfully respond to each new challenge, without the benefit of a guide making the best course clear. ASCO Connection Health-system pharmacy leaders face a wide range of challenges—from serving the needs of an increasing number of patients with fewer and fewer resources, to meeting the needs of staff who are expected to work harder, month after month, in the face of increasing complexity of care, to struggling to point their departments in a direction that will lead to success while navigating the seemingly endless stream of change. Within each section of this report, the results of each survey question are summarized in detail. 111–148, 124 Stat, The evolution of patient-centered care and the meaning of co-design, Joint Commission of Pharmacy Practitioners, Supporting patient independence in long term haemodialysis, strategic planning advice for pharmacy departments in hospitals and health systems, Pharmacy forecast 2016–2020: strategic planning advice for pharmacy departments in hospitals and health systems, December 2015, Use of prescription assistance programs after the Affordable Health Care Act, My child is sick; don’t call her a consumer, PTCB Certified Compounded Sterile Preparation Technician (CSPT) Program, Augmented intelligence in health care H-480.940, The executive guide to artificial intelligence: how to identify and implement applications for AI in your organization, Recommended quality measures for health-system pharmacy: 2019 update from the Pharmacy Accountability Measures Work Group, Occupation Safety and Health Administration, Controlling occupational exposure to hazardous drugs, Safe handling of hazardous drugs: ASCO standards, The ethical, legal, and regulatory issues associated with pharmacogenomics: systematically quantifying the literature, Clinical cancer advances 2018: annual report on progress against cancer from the American Society of Clinical Oncology, Identifying the root causes of drug shortages and finding enduring solutions, American Society of Health-System Pharmacists, Summit on drug shortages to examine impact on national security and health care infrastructure, National Academies of Sciences, Engineering, Medicine, Bottle of lies: the inside story of the generic drug boom, Cancer drug prices rise with no end in sight, National trends in prescription drug expenditures and projections for 2019, How the U.S. compares to Europe on biosimilar approvals and products in the pipeline, The specialty pharmacy boom: our exclusive update on the U.S. market, The top 15 specialty pharmacies of 2018: PBMs keep winning, Kentucky pharmacists have new authorities to improve patient, public health, For 2019, employers adjust health benefits as costs near $15,000 per employee, Healthcare industry consolidation: Walmart-Humana merger & Medicare Advantage plans. While affiliations with regional and national systems will likely continue, as reflected in FP responses (Figure 6, item 6), other strategies that integrate new telehealth technologies, such as home monitoring and electronically controlled medication administration, will become the norm in supporting rural healthcare. Most SPs and other stakeholders, such as manufacturers and payers, are invested in providing quality service (today defined by process indicators such as time to fill; adherence; outcomes specific to certain therapies, such as hepatitis C; or patient service indicators, such as abandoned-call rates). European markets have realized significant savings through the use of biosimilars, with certain biosimilars capturing 90% market share in some European countries, resulting in 70% cost reductions relative to originator product costs.2 The European Medicines Agency has 53 products on its approved list of biosimilars, with each European Union country controlling how these agents are used within its borders.3 By comparison, within the United States there are 19 products approved by the Food and Drug Administration, and only 7 are marketed. bBased on 2018 U.S. Census population data (estimated). Health-system pharmacists must continue to plan for manufacturing quality deficits resulting in recalls and shortages, as well as higher drug prices. Of course, the effort required to achieve recognition will also improve the care provided to patients—achieving that objective is essential. In 2019, the size of the Forecast Panel was increased in an effort to obtain
a more representative geographic distribution of FPs. The importance of pursuing diversity in the pharmacy workforce—a critical objective that requires deliberate strategic planning for health systems—is also discussed in that section. Their novelty lies in entering into contracts with health systems that guarantee access to drug supplies over longer periods than are offered in typical group purchasing organization contracts. Lead reform discussions at the state level, especially regarding improvements in Medicaid and state-based health plans, focusing on ways they can improve efficiency by being given more authority to manage medication therapy. Pharmacy departments have significant costs but limited ability to create billable revenue under the traditional fee-for-service structure. New products, particularly in the specialty categories, are priced not based on value but on what price the market will bear.8 The FPs were almost evenly split on whether government reimbursement rates for high-cost medications will be based on cost-
effectiveness analyses (Figure 5, item 6). Involving an institutional patient and family advisory council to guide this process can help mitigate this risk. Pharmacy departments should take advantage of institutional resources aimed at managing that risk but should also focus on prevention of events that are unique to their physical space and their staff workflows. Health-system pharmacy leaders possess skills that have often made them candidates for positions outside pharmacy. Concerns regarding workplace violence are discussed, as is the potential for the development of a “center of excellence” model for health-system pharmacy following the example of Magnet certification in nursing. Pharmacists should realign services to emphasize continuity of care, lead the way in using PROs in meaningful ways, embed shared decision-making into workflows, and offer solutions to tackle large public health challenges by leveraging pharmacist–patient relationships. (Observer). Vision StatementThe creation of a broad statement about the company’s values, purpose, and future direction is the first step in the strategic-planning process. Data from the University of Utah Drug Information Service show a 57% increase in ongoing and active drug shortages, from 176 in 2017 to 276 in 2019. Whether you’re creating a new strategic plan from scratch or you’re trying to breathe life into an old plan, I bet we can both agree that healthcare strategic planning is a tough process. As shown in Table 1, response rates per million population in each U.S. region ranged from 0.5 in the Pacific region (Oregon, California, and Washington) to 1.7 in the Western Plains states (Iowa, Kansas, Minnesota, Missouri, North Dakota, and South Dakota). Institutions Most health systems identify and track clinical, operational, and financial metrics related to pharmacy performance.3 Unfortunately, due to a lack of data and other factors, many metrics focus on structural and process efficiencies rather than clinical outcomes. Address correspondence to Dr. Nesbit (firstname.lastname@example.org). Scott Knoer, M.S., Pharm.D., FASHP, Chief Pharmacy Officer, Cleveland Clinic, Cleveland, OH. While these analyses are increasingly used by private insurers and Medicaid programs in some states, they are not used by traditional Medicare to determine coverage or reimbursement. Seventy-three percent of FPs believed health systems will need to offer salary premiums to attract and retain staff who work with hazardous medications (Figure 2, item 5). Forecast Panelists’ responses to the question, “How likely is it that the following will occur by the year 2024 in the geographic region where you work?”, Nearly all states currently enable collaborative drug therapy management by pharmacists in some form or fashion along a continuum from most restrictive to least restrictive (including independent prescribing authority). While the intent of pricing transparency is commendable, challenges in establishing a common charge master format and standardizing pricing information make it unlikely that the current proposals will provide meaningful information that could assist patients in making better decisions regarding their care. The strength (and possibly validity) of predictions generated using the “wisdom of the crowd” method is largely dependent on the nature of the panelists responding to the forecast survey. Pharmacy practitioners, on the other hand, were perceived by FPs as generally having difficulty in taking black swans in stride (Figure 8, item 2). Two out of three FPs indicated they do not believe health systems will assign pharmacists to provide education and support to parents who are uncertain about vaccinating their children (Figure 1, item 6). Although this seems overly optimistic for the general market, it is possible in health systems with strong formulary controls and active clinical programs. Strategic Planning Demographic Dilemma: Implications for Strategic Planning of Declining Global Birth Rates in Company Director Your Corporate Purpose Will Ring Hollow If the Company’s Actions Don’t Back It Up at Harvard Business Review. For example, expanding the role of pharmacy and therapeutics committees to include the oversight of laboratory testing can take advantage of well-established evidence-based evaluation resources that exist in many pharmacy departments. All of these challenges are made more acute in the absence of a robust, deliberately developed and maintained strategic plan. Two survey items addressed these concerns. However, 4 organizations (CVS Health, Cigna/ESI, Walgreens, and UnitedHealth Group) represent 70% of specialty drug revenues.5 Market domination by SPs aligned with insurers will likely continue, as will shared contracting with clients, restricted access to limited distribution medications, and closed SP payer networks. Without one, they would be hard-pressed to stay afloat in the dynamic environment that healthcare finds itself in. Health Care Planning & Evaluation Bruce Carruthers September 6, 2010 In business there are strategies that need to be fulfilled. G. Caleb Alexander, M.D., M.S., Professor of Epidemiology and Medicine, Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD. Address correspondence to Mr. Melby (email@example.com). Such government actions may include eliminating patent manipulations that prolong the time it takes for generic drugs to be introduced into the market, prohibiting financial deals among companies that prevent the timely introduction of generic drugs, and resolution of alleged price fixing among generic drug companies. Adopt practices that support occupational risk levels for handling of hazardous drugs in accordance with the ALARA principle while pursuing research that explores the validity of risk assessment and the effectiveness of risk mitigation, particularly as they relate to regulations. credentials would provide value in some settings, such as in rural or other medically underserved areas, and under emerging value-based reimbursement models, it would be easier to justify employing a Pharm.D./P.A. Cohen J. What’s holding back market uptake of biosimilars? Actively participate in discussions around increasing the transparency of medication and healthcare costs to the public, and contribute to the development of mechanisms of helping patients make more informed healthcare decisions. strategic planning process and communicate the outcomes in a way that inspires, invests, and ultimately drives change for these individuals. Address correspondence to Mr. Vermeulen (firstname.lastname@example.org). products, necessitating a specially trained and certified pharmacy workforce. Periodically lead “what if” discussions that probe how the pharmacy team would respond to a particular black swan event. Recognize the incentives and motivations that are encouraging disruptive developments in healthcare, particularly those driving entities not traditionally directly involved in delivering care. It also provides examples of the metrics, their use in decision-making and the variance reporting and improvement mechanisms. A majority of FPs (64%) agreed that changes in federal policy to regulate marijuana and medical cannabis in a manner similar to alcohol was very or somewhat likely (Figure 4, item 6). Facing these strategic questions, managers in health care are introducing strategic tools and methods, which were developed for the private sector, to help them provide the answers (Kramer, 2001). Those health systems already involved in specialty pharmacy programs should collect, analyze, and disseminate patient outcome data that demonstrate the value of services, thus differentiating their organizations from national providers. The Pharmacy Forecast should be shared with other senior health-system leaders and executives as a resource to help them understand the challenges facing pharmacy and to help them recognize the way emerging healthcare trends will affect many other areas of health systems. The near-even split of Forecast Panelists (FPs) in perceptions regarding this topic (Figure 4, item 1) demonstrates that there is a need for greater understanding of the potential for AI and the conditions required for AI to be effective. Rather, the report is, at its core, a provocative stimulant for the thinking, discussion, and planning that must take place in every hospital and health system in order for those organizations to succeed in their mission of caring for patients and advancing the profession of pharmacy. Please check for further notifications by email. FPs might have had a tendency to be more optimistic about issues “closer to home” than about topics less subject to control or influence by pharmacy practice leaders. State reforms have the potential to expand access, improve competition and patient choice, increase transparency of prices and performance, and reduce burdensome regulations, expanding opportunities for pharmacists. Develop and implement health system–based programs that respond to those same drivers. (Patient-Centered Care). A cardiology department, a hemodynamic unit, or an electrophysiology unit can be an appropriate level, as long as their plans align with other plans … Fifty-seven percent of FPs indicated they believe it is likely that colleges and schools of pharmacy will offer a joint doctor of pharmacy (Pharm.D.) Enter into discussions with local and state employers and employer coalitions, identifying ways to partner with them directly to improve the quality and efficiency of care provided by health systems to their employees. Purchase pharmaceutical products produced in the United States or European Union whenever possible. Pharmacists with P.A. However, they quickly learned that 80 pharmaceutical manufacturing facilities were concentrated in Puerto Rico. The demand for postgraduate training programs continues to increase each year, with demand outpacing supply; however, 64% of FPs felt it was unlikely that health systems would offer nontraditional residency programs (Figure 2, item 4). (The Black Swan). As long as you articulate those differing opinion in the context of your own organization’s strategic planning process and chart a course for your organization that is consistent with your beliefs, then the Pharmacy Forecast has met its objective of encouraging planning efforts of health systems. However, pharmacy leaders who accept responsibility for other departments must also see and exploit the strengths of their other departments and drive collaboration across all areas they lead. The duties a technician can perform will be nonjudgmental; however, they will continue to take on additional tasks that will necessitate additional education, training, and credentials. fluids. Unless Congress acts to reform coverage and reimbursement rules, Medicare will continue to pay for all drugs with FDA-approved indications and selected off-label indications, without regard to cost-effectiveness standards. fluids such as normal saline became unavailable. As the complexity of healthcare delivery continues to increase, the challenges facing pharmacy leaders will escalate—as will the opportunities for growth in innovation and influence. The members of the Pharmacy Forecast Advisory Committee were instrumental in considering hundreds of factors that may influence the future of health-system pharmacy and distilling those ideas into a coherent survey. As an example, meeting new quality standards focused on sterile production and the handling of hazardous drugs by healthcare workers4 have required extensive investment in infrastructure and added labor expense despite limited evidence that systemic shortcomings in patient or worker outcomes exist. (Pharmacy Workforce). Pursue value-based contracts with payers that enable the health system to take advantage of the unique capabilities of health-system pharmacists involved in patient care. ASHP Research and Education Foundation, Bethesda, Maryland, Jannet M. Carmichael, Pharm.D., BCPS, FCCP, FAPhA, American Society of Health-System Pharmacists, Bethesda, Maryland, University of Michigan, Ann Arbor, Michigan, University of Utah Health, Salt Lake City, Utah, James M. Hoffman, Pharm.D., M.S., BCPS, FASHP, St. Jude Children’s Research Hospital, Memphis, Tennessee, University of Virginia Health System, Charlottesville, Virginia, Cedars-Sinai Medical Center, Los Angeles, California, Pamela L. Stamm, Pharm.D., BCPS, BCACP, CDE, FASHP, Ross W. Thompson, B.S.Pharm., M.S., FASHP, Tufts Medical Center, Boston, Massachusetts, Robert Edward D’Eramo, Pharm.D. The organizational level at which the strategic planning process is relevant depends on the unit's size, its complexity and the differentiation of the service provided. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. The total value of the contract represents less than 5% of the total budget for UUDIS. Many pharmacy departments are organized by setting of care. L. No. September 21, 2016. Most FPs (58%) described their practice setting as a teaching hospital or health system, while 15% of FPs were from nonteaching hospitals or health systems and 13% from academia (essentially unchanged from 2019). These tools should not be implemented until there is a clear plan for how the information will be used, and careful consideration should be given to the overall volume of questionnaires posed so as to avoid patient frustration and disengagement. A bit of a “dog’s breakfast” of topics, this section includes a discussion of emerging advanced computing technologies, genomics, and future concerns regarding medical cannabis and provides important guidance on those issues. This shortage of programs and the increasingly high debt load of new graduates may decrease interest in residency training somewhat, but health systems will continue to require completion of residency training as a requirement for employment. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. The ASHP Research and Education Foundation (“the Foundation”) is pleased to present the eighth edition of the annual Pharmacy Forecast. The 2020 Pharmacy Forecast includes a number of topics related to the role of evidence in the emergence of new practices and their impact on health systems. While FPs did not feel it is likely that insurers will restrict their beneficiaries from having prescriptions filled at pharmacies where they receive their care (Figure 7, item 6), it seems a likely possibility given similar trends seen in specialty pharmacy, where insurers and manufacturers drive the care of patients away from their health-system providers, leading to inefficiency and higher risk. Legislative and regulatory efforts may require certification for personnel involved in sterile product compounding. This year, we again surveyed a large group of individuals and obtained at least 1 response from every state with the exception of 9 (Alaska, Arkansas, Delaware, Hawaii, Idaho, Nebraska, Oklahoma, Rhode Island, and West Virginia); in comparison, 7 states were not represented in the previous survey. Bruce E. Scott, B.S.Pharm., M.S., FASHP, (Ret.) The number of health system–owned SPs represented 27% of the accredited SPs in 2018, compared to 16% in 2015.4 Smaller, independent SPs are declining, representing 47% of accredited SPs in 2018, compared to 59% in 2015. Pharmacists’ acknowledged ability to drive efficiency will allow them to contribute substantially to their organizations. The continued advancement of pharmacy technicians and their role in health systems, as well as operational challenges surrounding the handling of hazardous products, are highlighted in this edition of the Pharmacy Forecast. Dr. Conti is an unpaid special consultant to FDA’s Office of Generic Drugs.The authors have declared no other potential conflicts of interest. In a section on patient-centered care, Meghan Swarthout and Caleb Alexander describe a wide range of trends that extend the discussion on this topic provided in the 2019 Pharmacy Forecast. Invest in the collection of PRO data using validated questionnaires, and make the information readily retrievable in the EHR for frontline staff. Health-system SPs will be challenged to demonstrate that their ability to coordinate patient care results in superior outcomes. Develop pharmacy-specific measures associated with outstanding patient and organizational outcomes, which may be used as the framework for a national recognition program designating pharmacy department excellence. Strategic planning in health care organizations involves outlining the actionable steps needed to reach specific goals. Organizational restructuring can foster collaboration among pharmacists across settings, encouraging alignment that enhances communication and shared ownership of clinical outcomes. The 2020 Pharmacy Forecast Advisory Committee (see membership list in the Foreword) began the development of survey questions by contributing lists of issues and concerns they believed will influence health-system pharmacy in the coming 5 years. Given the complexity, uncertainty, and pace of change in healthcare today, strategic planning must be a continuous process. Invite top institutional leaders to participate in the pharmacy department’s exploration of how to enhance responsiveness to seemingly improbable events that have massive consequences. Forecast Panelists (FPs) responded to questions regarding the symbiotic relationship between pharmacy education and training and workforce issues. The Foundation is also grateful to Omnicell for their support of the Zilz fund, which has made the Pharmacy Forecast possible. Strategic plans should be reviewed frequently, allowing for tactical adjustments in course over time as trends (those discussed in this report and others that were not predicted) emerge. Market share growth will be impeded by challenges in converting patients who are stable on originator products to biosimilars and by benefit designs that do not incent patients to use biosimilars. Key questions for practice leaders related to black swan resiliency include: Are communications among pharmacy team members free flowing across lines of authority versus being confined to a rigid chain of command? Here’s how Medicare works, ASHP statement on the role of health-system pharmacists in emergency preparedness, Accelerate—building strategic agility for a faster-moving world, Accelerate! Why ‘Strategic Plans’ Are Rarely Strategic—or Effective Effective managers can list their goals on a note card. Despite enormous scrutiny, drug prices continue to increase, limiting many patients’ access to drugs. In this section of the Pharmacy Forecast, drivers of reform are examined. A large majority of Forecast Panelists (FPs) indicated that it is likely that pharmacy departments will establish the means to prove the value of the work they do (Figure 3, item 1). The authors have declared no potential conflicts of interest. When signing local drug acquisition contracts, insist on disclosure of the source and site of manufacture, and ensure that contracts signed by group purchasing organizations on behalf of health systems also include disclosure. Health systems should collaborate with colleges and schools of pharmacy to develop a range of training options for pharmacists to ensure an adequate supply of staff capable of meeting the future needs of the healthcare system. For more? Genomic testing has evolved into the standard of care at many health systems, resulting in the incorporation of molecular tumor boards, pharmacogenomics services and clinics, and medical genetics services. In Figure 8, the results for item 1 tilt to the right, suggesting that, in the view of FPs, many health-system pharmacy leaders are at least somewhat skillful in helming successful staff responses to black swans. In this industry especially, healthcare planning must take into account potential government policy changes, technological advancements and economic trends that could change an organization’s operations in a significant way. (Evidence-based Pharmacy Practice). The emergence of health system–based specialty pharmacy programs is an example of ventures that many institutions have implemented to create new revenue streams. That list was then expanded and refined through an iterative process, resulting in a final set of 8 themes, each with 6 focused topics on which the survey was built. Address correspondence to Dr. Fox (Erin.Fox@hsc.utah.edu). Significant investment has been made in retail pharmacy–based clinics, and respondents expressed uncertainty regarding patient interest in these services (Figure 1, item 5). Hence, it is time for a revolution… While 77% of FPs indicated that health-system pharmacies will provide superior quality relative to national providers (Figure 6, item 3), proving that advantage will be difficult. Boeing has announced it will contract directly with southern California’s Memorial Care Health System for employee benefits, as it has with other health systems in Seattle, St. Louis, and Charleston.5 Intel has a direct contract with Presbyterian Healthcare Services in New Mexico, and Walmart and Lowes have negotiated bundled payment contracts to cover certain procedures at major hospitals throughout the United States.6 Smaller employers who are not self-insured may want to enter into such arrangements but, in tight labor markets, may find it more difficult to direct employees to specific providers. 1. Conrad Emmerich, M.B.A., Senior Vice President of Operations, Wake Forest Baptist Health, Winston-Salem, NC. Examples of a “seemingly improbable event”: demise of the pharmacy benefit management industry; advances in artificial intelligence supplanting most current clinical roles of pharmacists; disintermediation of the retail pharmacy industry by the likes of Amazon. It is critical that leaders pursue opportunities to advocate for reasonable regulations based upon evidence. For permissions, please e-mail: email@example.com. The methods used to develop the 2020 Pharmacy Forecast were similar to those used in the previous editions, drawing on concepts described in James Surowiecki’s book The Wisdom of Crowds.1 According to Surowiecki, the collective opinions of “wise crowds”—groups of diverse individuals in which each participant’s input is provided independently, drawing from his or her own locally informed points of view—can be more informative than the opinion of any individual participant. FPs were split on the question of whether pharmacy technicians will have education and training comparable to that of staff in other fields or be compensated similarly (Figure 2, item 2). Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. While these clinics may serve an important role in some communities as a “consumerist” delivery model that frames healthcare as transactional rather than relationship based, they often conflict with principles of patient-centered care.11.
Forecast Panelists’ responses to the question, “How likely is it that the following will occur by the year 2024 in the geographic region where you work?”.