The editorial staff of AJHP has provided substantial support for this publication, and we appreciate their assistance. Oxford University Press is a department of the University of Oxford. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (, William A Zellmer, B.S.Pharm., M.P.H., FFIP. The capacities needed by health managers and leaders to respond to current and emerging issues are not yet well understood. DOI: 10.1200/JOP.0936501 Journal of Oncology Practice Medicare for All? Schumock GT, Stubbings J, Hoffman JM et al. Their ability to identify and form partnerships with entities outside pharmacy (even outside healthcare) will also be essential to develop truly innovative ventures such as insourcing pharmacy benefits management for employees to keep revenue within the health system. The panel was carefully balanced across the census regions of the United States to reflect a representative national picture. 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. Develop and implement policies and procedures that protect all staff involved in the handling of hazardous medications, including appropriate education, training, and certification of personnel, regardless of the health status of the individual employee. A majority of FPs (78%) believe price disclosures will be required in future direct-to-consumer advertising (Figure 5, item 4), but just over half of FPs believe that price controls will be enacted for some essential medications, such as insulin (Figure 5, item 5). The future of federal and state reforms, the continued emergence of value-based payment models, and disruptive phenomena affecting healthcare are all examined. Onasemnogene abeparvovec-xioi (Zolgensma, AveXis). 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. For permissions, please e-mail: journals.permissions@oup.com. Michael J. Melby, B.S.Pharm., M.S., Director of Innovation and Activation, Indiana University Health, Indianapolis, IN. Sustaining delivery of care in rural areas is an important necessity of our healthcare systems. Contact Us This review examines the current and … The remainder of FPs included leaders and practitioners at varying levels and with varying titles. products, necessitating a specially trained and certified pharmacy workforce. Forecast Panelists (FPs) differed as to whether any increased patient burden from the demands of engagement may decrease health outcomes (Figure 1, item 1). Pharmacy is responsible for preparing and distributing some hazardous products. Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. Whether it is a shift in philosophy to focus on more value-based care or navigating the impact of implementing the Affordable Care Act here in the United States, significant shifts and changes have occurred and are occurring every day. Whether or not a fully realized single-payer system is achieved, broadening access to efficient care—particularly outside the acute care setting—is essential. Improving patients’ health outcomes and satisfaction scores are particularly important goals, so the hospital’s senior leadership would like to more closely integrate patients into creating organizational policies that ultimately shape their care experiences. The authors have declared no potential conflicts of interest. Given the current evidence gaps, these results were unexpected. 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. Organizational restructuring can foster collaboration among pharmacists across settings, encouraging alignment that enhances communication and shared ownership of clinical outcomes. It will be difficult for health-system SPs to compete with market-dominating SPs. Finally, as discussed previously, Bill Zellmer, Scott Knoer, and James Hoffman provide a discussion of the black swan concept, introducing a new component for improving strategic planning around potentially catastrophic future events. An audio interview that supplements the information in this article will be available at www.ajhpvoices.org. Strategic planning includes all measures taken to provide a broad picture of what must be achieved and in which order, including how to organise a system capable of achieving the overall goals. Also acknowledged for assistance with various aspects of the process are Eliza Asherian, Julia Beatty, James Blackmer, Kelly Brookbank, Stephanie Brown, David Chen, Lillian Clark, Dan Cobaugh, Rachael Freeman, Camryn Froerer, Brandi Gore, Laura Halsey, Clayton Hamilton, Chanese Hampton, Ryan Hays, Lynn Hoffman, Collin Jakubecz, Erica Krantz, Jennifer Lee, Jordan Long, Alexandrea Lux, Scott Mambourg, Maryam Mohassel, Derek Montgomery, Barbara Nussbaum, Shea O’Brien, Antoniette Parris, Jeff Schempp, Leticia Vargas, and Kjersti Vharen. FPs were divided as to whether health systems would offer an ASHP/ACPE-accredited technician education program (Figure 2, item 3). Health systems must work towards policies for the ethical use of this potentially very large volume of data.7 A majority of FPs agreed that development of such policies in health systems was likely (Figure 4, item 4). Starting a business or health care organization we need to use strategy planning. Walmart, in talks to acquire insurer Humana, may combine a PBM, pharmacy, and insurer under a single corporate umbrella.4 The retail giant will cater to its 140 million weekly customers—many of whom are senior citizens and lower-income Americans who are Medicare or Medicaid beneficiaries—with low-cost health services, including basic primary care and chronic disease management services. When done right, “a strategic map” will create the perfect ecosystem for sustained success by zeroing in on specific areas for action. Slightly more than half (53%) of FPs did not feel that new companies will decrease future shortages (Figure 5, item 3). Editorial Roster Cohen J. What’s holding back market uptake of biosimilars? We then asked FPs to predict, using a linear analog scale from 0 to 100%, how prepared they feel they, their organizations, their patients, and their communities are to successfully respond to black swan events that will occur in the coming 5 years. degree (Figure 2, item 6). (Pharmaceutical Supply Chain). 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. 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. Most of the FPs (81%) had been in practice for greater than 10 years, and 46% had been in practice for greater than 20 years (down from 58% of FPs in 2019). This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. Conquer Cancer Foundation Changes in state laws and regulations to require higher levels of pharmacy technician education and training must occur before pay scales for pharmacy technicians will be comparable to those of other ancillary healthcare providers. It is only through a continuous process that organizations can be responsive to changes that are sure to affect our profession, organizations, and patients. However, the definition of a strategic plan differs among different people, according to … Boeing bypasses traditional health insurance model in contract with MemorialCare health system: a sign of things to come? In 2018, ASHP established the Technician Forum to provide a home for these essential practitioners and serve as the collective voice for pharmacy technicians by supporting their advancement and professionalization. A large group of FPs (16%) listed their primary position as “clinical pharmacist – specialist,” and another 13% described their primary role as faculty. It is likely that some form of direct governmental price negotiation will be a part of any new plan, but significant price decreases for health systems are unlikely in the near future. Given the challenge of achieving consensus on which drugs should be included on such a list, this result was surprising. The ASCO Post While the cost of healthcare, and specifically the out-of-pocket financial responsibility borne by patients, is a critical issue in this section, several key areas surrounding patient decision-making, including an exploration of where patients choose to seek care in the future and concerns regarding vaccine choices, are addressed as well. 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. 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. Today’s strategies for providing care in rural areas include alignments with regional systems, creation of referral networks, and mergers or acquisitions. Forecasting future events is an important exercise that can help leaders create well-informed strategic plans. Institutions that achieve recognition advertise the designation as a means of improving recruitment of talented staff and raising their organization’s brand strength.1 FPs were split on the possibility of creating a similar recognition program for health-system pharmacy (Figure 3, item 4). Develop and implement health system–based programs that respond to those same drivers. While the responses indicate a concern regarding the impact that such burden could have, patients may be willing to embrace complex self-care management.6,7 The responses may also reflect confidence that individual- and health system–level factors can mitigate potential burdens. Of all the items in this section of the Forecast, the strongest level of FP agreement was with the question examining pharmacists having comprehensive responsibility for a panel of patients across the continuum of care (Figure 1, 
item 3). Fifty-four percent of FPs felt that such federal action will occur in the future (Figure 5, item 2). Address correspondence to Ms. White (rxsjw@yahoo.com). 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. 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. 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). Lee C Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, UK HealthCare, and Professor of Medicine and Pharmacy, University of Kentucky, Address correspondence to Mr. Vermeulen (. Bruce E. Scott, B.S.Pharm., M.S., FASHP, (Ret.) Is the pharmacy team well equipped—through a wide range of experiences, perspectives, and information sources—to identify and assess external developments that could have large consequences (either positive or negative) for the pharmacy enterprise? Patients (Figure 8, item 5) and the communities in which they live (Figure 8, item 6) were downgraded by FPs with respect to their capacity to adapt to unpredicted disruptive events. TAPUR Study. Health insurance coverage eight years after the ACA: fewer uninsured Americans and shorter coverage gaps, but more underinsured (February 7. The value of the report, however, is defined by its use by health-system pharmacists and health-system pharmacy leaders as they use the report to inform their strategic planning efforts. 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?”. Develop and implement improved documentation systems that discretely capture pharmacy impact and enable analysis of the value of pharmacy services. Health-system SPs will be challenged to demonstrate that their ability to coordinate patient care results in superior outcomes. James M. Hoffman, Pharm.D., M.S., BCPS, FASHP, Chief Patient Safety Officer and Associate Member, Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN. (Patient-Centered Care). DOI: 10.1200/JOP.0936501 Journal of Oncology Practice - The pace of this change varies by region—regions with dominant payers are moving more slowly toward full capitation. This will be true not only of residency program recruitment but also recruitment of students in colleges and schools of pharmacy, where diversity must also be improved. Collins SR, Bhupal HK, Doty MM. Pharmacists’ acknowledged ability to drive efficiency will allow them to contribute substantially to their organizations. The safe handling of hazardous drugs is obviously important, but while exposure risk was established decades ago, limited data have been generated since the adoption of Occupational Safety and Health Administration (OSHA) guidelines in 1986.5 Evidence supporting many strategies, such as closed system drug transfer devices and external ventilation, is lacking. There is currently limited consensus on the characteristics of “high performance” in health-system pharmacy, and performance metrics must be defined before departments can be judged. Under fee-for-service, providers seek more reimbursement from payers, while capitated value-based systems seek opportunities to cut spending without compromising quality. Legislative and regulatory efforts may require certification for personnel involved in sterile product compounding. Those organizations involved in education or training should consider the use of the Pharmacy Forecast as a teaching tool. As value-based reimbursement evolves, health systems should consider value-based pharmacy designs, which may not only improve clinical outcomes but also reduce total costs of care. Healthcare Executive, Eden Prairie, MN. Pharmacists and technicians who complete additional training and/or certification may qualify for higher salaries, but this would be based on additional credentials, not necessarily the compounding of hazardous medications. Health-system pharmacists must continue to plan for manufacturing quality deficits resulting in recalls and shortages, as well as higher drug prices. (Healthcare Marketplace). Lee C Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, Meghan D Swarthout, Pharm.D., M.B.A, G Caleb Alexander, M.D., M.S, Diane B Ginsburg, B.S.Pharm., M.S., Ph.D., FASHP, Katie O Pritchett, Ph.D., Lecturer, Sara J White, M.S., FASHP, Jennifer Tryon, Pharm.D., M.S., FASHP, Conrad Emmerich, M.B.A, Todd W Nesbit, Pharm.D., M.B.A., FASHP, William Greene, B.S.Pharm., Pharm.D., BCPS, FASHP, FCCP, Erin R Fox, Pharm.D., BCPS, FASHP, Rena M Conti, Ph.D, Bruce E Scott, B.S.Pharm., M.S., FASHP, Frank Sheehy, B.A., M.B.A, Michael J Melby, B.S.Pharm., M.S, Mark A Lantzy, James M Hoffman, Pharm.D., M.S., BCPS, FASHP, Scott Knoer, M.S., Pharm.D., FASHP, William A Zellmer, B.S.Pharm., M.P.H, ASHP Foundation Pharmacy Forecast 2020: Strategic Planning Advice for Pharmacy Departments in Hospitals and Health Systems, American Journal of Health-System Pharmacy, Volume 77, Issue 2, 15 January 2020, Pages 84–112, https://doi.org/10.1093/ajhp/zxz283. Today, health care providers require more patient-centric, value-based approaches, whereas many of their current systems follow older, more traditional strategy … 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. Heymach J, Krilov L, Alberg A et al. We turn to Todd Nesbit and Bill Greene for a discussion surrounding the role of evidence in a wide range of pharmacy practice areas. Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. Again, this distribution was not substantially different from that of the 2019 panel. Should state laws and regulations mandate accredited training for technicians, many institutions will collaborate with community colleges to meet their training needs. Dr. Fox is also a member of the AJHP editorial board. Lead your institution to proactively develop data systems that support the development of validated AI applications, providing the opportunity to redeploy human resources to other unmet patient care needs. program would be challenging to offer and unlikely to provide substantial payoff for graduates. Develop and implement new technology in telemedicine to improve access to the care of pharmacists in medically underserved communities. (June 20. Those changes are unlikely in the near future. 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. 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. Dr. Hoffman is a member of the AJHP editorial advisory board. Unique characteristics of each hospital and health system may suggest important differences in the potential impact of emerging trends, or individuals may simply disagree with the predictions made in this report. Does the department’s planning process engage all team members in strategic thinking?5, Do pharmacy leaders periodically facilitate “what if” discussions about how the department could respond to a seemingly improbable event?e. Andrawis M, Ellison C, Riddle S et al. (May 01, 2009) Dr. Knoer and Mr. Zellmer are contributing editors of AJHP. Routine communication and collaboration on quality improvement projects will yield efficiencies, helping to financially justify the added time needed for this work. Most FPs believed it likely that patient-reported outcomes (PROs) will play a role in making care decisions (Figure 1, item 2). Strategic health planning involves creating objectives and setting goals for where a company would like to go in the future, and then constructing a plan to achieve these objectives. Please check for further notifications by email. Those health systems not already offering specialty pharmacy services should carefully evaluate the cost and risk of creating new programs and consider business and care delivery partnerships instead of developing programs on their own. The mixed survey response is likely a reflection of the complexity that would be involved in establishing such a recognition program. 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. 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? As in the past, survey respondents—Forecast Panelists (FPs) —were selected by ASHP staff after nomination by the leaders of the ASHP sections. This is inconsistent with national trends and attention to the preparation of these medications. 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. Periodically lead “what if” discussions that probe how the pharmacy team would respond to a particular black swan event. Approximately half of FPs believe that a publicly accessible hospital charge master will provide value to consumers (Figure 6, item 5). Integration across these service lines should entail the development of new expertise and the development of strong partnerships with existing subject matter experts (e.g., cell therapy laboratories). 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. While it is not possible to be “black swan proof,” it is possible to be “black swan robust”—with deliberate, consistent, and effective strategic planning, an individual, organization, or community can be better prepared to successfully respond when black swan events inevitably occur, and preparation for those events is an essential leadership challenge. Nontraditional residency programs, as well as certificate programs, would allow pharmacists to gain required training, expand their skills, and widen their employment options. Take stock of what is happening within the organization and its patient, payer, provider, and competitive market. Two topics that are often included in the Pharmacy Forecast—the healthcare marketplace and healthcare reform—also appear in this year’s edition. 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). 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). Conrad Emmerich, M.B.A., Senior Vice President of Operations, Wake Forest Baptist Health, Winston-Salem, NC. published online before print Despite widespread recognition that healthcare is too expensive, impersonal, and inaccessible and produces the worst outcomes in the developed world, no consensus has emerged on how to improve it.
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