As a stimulant for thought and discussion, dissenting opinions can be constructive and valuable—provided those who express disagreement can offer alternative views and recommendations for action that go along with their perspectives. This edition of the report differs from the first 7 editions, just as each previous version differed from earlier versions. 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. The authors have declared no other potential conflicts of interest. In pharmacy, diversity at every level of staffing must be a leadership focus. Drug shortages have become so problematic that new businesses are emerging with missions to improve supply, including health system–owned or not-for-profit companies. 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. 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. Michael Melby and Mark Lantzy contribute a discussion of healthcare reform challenges that will face health systems in the coming years. About 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. This is inconsistent with national trends and attention to the preparation of these medications. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. Frank Sheehy, B.A., M.B.A., (Ret.) For significant savings to occur, more products are needed, along with greater discounts from the originator prices. Creation of the Pharmacy Forecast 2020 report was supported by an unrestricted grant from Omnicell, Inc., to the David A. Zilz Leaders for the Future Fund of the ASHP Research and Education Foundation. However, skills provided in joint Pharm.D./M.B.A. Boeing bypasses traditional health insurance model in contract with MemorialCare health system: a sign of things to come? Given the challenge of achieving consensus on which drugs should be included on such a list, this result was surprising. Oxford University Press is a department of the University of Oxford. Health systems must appropriately compensate pharmacists and technicians who possess sterile products certifications in order to ensure an adequate workforce dedicated to this fundamental pharmacy responsibility. program would be challenging to offer and unlikely to provide substantial payoff for graduates. 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. The Pharmacy Forecast is not intended to be a quantitatively or even qualitatively (directionally) accurate prediction of future events. The forecast survey instructed FPs to read each of the 48 scenarios represented in survey items and consider the likelihood of those scenarios occurring in the next 5 years. From the 1960s into the 1980s, it was all about the buildings: The cost-based payment environment of the time spurred strategic focus on expanding the physical footprint with new brick-and-mortar facilities. The editor also again recognizes the leadership and vision of William A. Zellmer, the founding editor of the ASHP Foundation Pharmacy Forecast series, for creating a resource for the profession that continues to have significant value. 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. 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. Strategic Information System Planning (SISP) is instrumental in making informed decisions to achieve the health organizations' goals and objectives. A large group of FPs (16%) listed their primary position as “clinical pharmacist – specialist,” and another 13% described their primary role as faculty. Implement strategies for increasing the use of biosimilars, including techniques that have historically been useful in increasing use of conventional generic medications, such as actively correcting misinformation about safety and effectiveness of biosimilars and encouraging payers to offer patients lower out-of-pocket costs for those agents. These new ventures seek to address shortages largely by outsourcing additional production to contract manufactures. Develop and implement new technology in telemedicine to improve access to the care of pharmacists in medically underserved communities. Dr. Toftle, a physician now retired from practice whose main role is in the hospit… 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. Importantly, the process of strategic planning should not be limited to an annual process, producing a strategic plan which is then largely ignored until the following year when a revised plan is created. Sustaining delivery of care in rural areas is an important necessity of our healthcare systems. As many of those new ventures will likely arise in the ambulatory care setting, pharmacy leaders should expand their understanding of operational and financial nuances of that setting. The remainder of FPs included leaders and practitioners at varying levels and with varying titles. 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). Although this seems overly optimistic for the general market, it is possible in health systems with strong formulary controls and active clinical programs. The author has declared no potential conflicts of interest. The development of an accredited program by individual institutions is not cost-effective, nor is it an efficient means to provide this level of training. Healthcare Executive, Eden Prairie, MN. Purchase pharmaceutical products produced in the United States or European Union whenever possible. Develop comprehensive medication-use policies around medical cannabis at the institutional, state, and federal levels, ensuring that policies and practices focus on reducing patient risk while preserving patient’s right to access treatment. Starting a business or health care organization we need to use strategy planning. 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. For example, infectious diseases and antimicrobial stewardship clinicians might be aligned as one team across acute care and ambulatory practice, sharing responsibility for patient outcomes longitudinally for programs like outpatient parenteral antimicrobial therapy, with pharmacists potentially rotating between acute care and ambulatory care responsibilities. 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. 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. Katie O. Pritchett, Ph.D., Lecturer, McCombs School of Business, The University of Texas at Austin College of Pharmacy, Austin, TX. Many educators and residency preceptors use the report as part of coursework, seminars, or journal club sessions to help engage pharmacy trainees in thinking about the future of the profession they are preparing to enter. Collaboration with clinical informatics colleagues is needed to address current data shortfalls. to improve health systems’ efficiency. In the future, to drive efficiency, reforms that focus on population health, incentivizing care delivery in the most efficient location possible, and encouraging investment in nonhealthcare interventions that directly impact health and healthcare resource consumption (e.g., food insecurity and housing) will be necessary. 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. It engages the entire organization. Professional English and Academic Editing Support, 2318 Mill Road, Suite 800, Alexandria, VA 22314, © 2020 American Society of Clinical Oncology. All past editions of the Pharmacy Forecast can be found on the ASHP Foundation website at http://www.ashpfoundation.org/pharmacyforecast. This … and physician assistant (P.A.) Strategic planning (SP) is one of the more popular management approaches in contemporary organizations, and it is consistently ranked among the five most popular managerial approaches worldwide (Rigby and Bilodeau 2013; Wolf and Floyd 2017).Typically operationalized as an approach to strategy formulation, SP includes elements such as analysis of the organization's … 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. ASCO Connection Those changes are unlikely in the near future. The American Nurses Association has been successful with its Magnet Recognition Program. 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. Slightly more than half (53%) of FPs did not feel that new companies will decrease future shortages (Figure 5, item 3). It is also important to note that not all violence is physical—verbal and emotional abuse must also be recognized and addressed. Employers, in an effort to reduce costs and improve outcomes, will continue contracting directly with providers. FPs clearly acknowledged the role cost will play in patient decision-making, with 70% believing that some patients may decline therapy after considering the costs, benefits, and risks of treatment (Figure 1, item 4), a decline from 82% for a similar question in the 2016 Pharmacy Forecast.9 This change may reflect the increase in patient assistance programs that may now blunt the impact of rising patient out-of-pocket costs despite continued drug price increases.10 Out-of-pocket medication costs should be a part of shared decision-making discussions with patients, especially when multiple treatment options exist, with close attention paid to the impact of forgoing treatment. It examines obstacles that sit between where your healthcare organization is and where it should be. When done right, “a strategic map” will create the perfect ecosystem for sustained success by zeroing in on specific areas for action. Partner with postacute care providers to enhance communication and care coordination between clinical teams. Responses were received from 283 (an 87.1% response rate, up slightly from the 85.4% response rate in 2019). 5, no. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. However, the definition of a strategic plan differs among different people, according to … They did not consider where drug products were made, perhaps assuming sufficient geographic dispersion so that a single natural disaster could not significantly disrupt supplies. In order for data from validated PRO tools to be integrated into daily, frontline practice, pharmacy leaders must allocate resources for infrastructure to collect this information directly from patients. 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. Barnes T, Winfrow M, Laboi P, Wilkie M. Vermeulen LC, Eddington ND, Gourdine MA et al. A majority of FPs agreed that pharmacy leaders will continue to be expected to bring innovative strategies to bear in their departments (Figure 3, item 2). 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. Tisagenlecleucel (Kymriah, Novartis) and axicabtagene ciloleucel (Yescarta, Kite Pharma). Andrawis M, Ellison C, Riddle S et al. Identify and implement strategies that minimize the inefficiencies brought to the healthcare system by fiscal and supply chain intermediaries (PBMs, GPOs, and wholesalers) when their services do not add real value to health-system pharmacy performance. 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. Consideration must be given to patients’ time investment in answering these questions. Also similar to the 2019 survey, FPs reported that their primary organizations offered very diverse services, including home health or infusion care (54% of FPs), specialty pharmacy (61% of FPs), ambulatory care (82% of FPs), pediatric care (61% of FPs), and hospice care (41% of FPs). 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. Incentives may also result in unintended consequences such as drug manufacturers focusing efforts on a few products and discontinuing other products that may also be clinically relevant but not deemed “essential.” There is little evidence that such incentives would alleviate shortages, at least in the short term. 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 Foundation is also grateful to Omnicell for their support of the Zilz fund, which has made the Pharmacy Forecast possible. 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. Journal for Nurses in Professional Development: 11/12 2017 - Volume 33 - Issue 6 - p 318-319 Again, this distribution was not substantially different from that of the 2019 panel. 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. 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. The 2020 Pharmacy Forecast is intended to assist with strategic planning efforts by health-system leaders. In this section of the Pharmacy Forecast, drivers of reform are examined. Acute care pharmacists should document discharge summaries for community and ambulatory care pharmacists, paralleling physician documentation in EHRs, to make this process efficient. Such therapies are analogous to blood and stem cell transplantation in many aspects. 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. Another possible solution discussed at various stakeholder meetings is the establishment of an essential drug list (such as the list maintained by the World Health Organization7), with targeted incentives to ensure availability of key products. There is a dearth of evidence linking most current metrics with truly impactful patient outcomes, yet huge investments are made in structural and process improvements in the hope that outcomes will also improve. Despite the constancy of change in the healthcare marketplace, the demand for patient-centered care shows no signs of abating. Address correspondence to Mr. Melby (mmelby@iuhealth.org). For example, Kentucky recently joined California and a few other states in expanding the pharmacist scope of practice, granting independent prescribing authority (to be exercised in collaboration with physicians) under approved protocols for a wide range of conditions, including acute infections, tobacco cessation, and opioid use disorder.1. degree (Figure 2, item 6). 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. (Patient-Centered Care). 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. 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). The panel was carefully balanced across the census regions of the United States to reflect a representative national picture. Dr Alexander is past chair of the Food and Drug Administration’s Peripheral and Central Nervous System Advisory Committee, has served as a paid advisor to IQVIA, is a cofounding principal and equity holder in Monument Analytics (a healthcare consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation), and is a member of OptumRx’s National P&T Committee. 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. 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. After the strategic course is determined in the initial planning session, the group should meet at least annually. Strategic planning in health care organizations involves outlining the actionable steps needed to reach specific goals. This review examines the current and … Despite enormous scrutiny, drug prices continue to increase, limiting many patients’ access to drugs. Given the current evidence gaps, these results were unexpected. Studies to date have been country-specific and have not integrated different international and multi-level insights. Elevating your precepting: Bringing career planning and professional development to the forefront, Virtual Summit on Safe, Effective, and Accessible High-Quality Medicines as a Matter of National Security, Reduction of phone interruptions post implementation of a central call center in community pharmacies of an academic health system, Pharmacy-facilitated medication history program at a community teaching hospital: A pre-post study in an emergency department, ASHP National Surveys of Pharmacy Practice in Hospital Settings, Population Health Management Theme Issues, Practice Advancement Initiative Collection, Transitions of Care/Medication Reconciliation, Emergency Preparedness and Clinician Well-being, Author Instructions for Residents Edition, http://www.ashpfoundation.org/pharmacyforecast, http://www.ihi.org/communities/blogs/evolution-of-patient-centered-care-and-the-meaning-of-co-design, https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf, https://www.bpsweb.org/bps-specialties/compounded-sterile-preparations-pharmacy/, https://www.ptcb.org/get-certified/cspt#.XQfq3vlKh-U, https://www.jointcommission.org/certification/medication_compounding.aspx, https://money.usnews.com/careers/best-jobs/physician-assistant/salary, https://www.nursingworld.org/organizational-programs/magnet, https://policysearch.ama-assn.org/policyfinder/detail/augmented%20intelligence?uri=%
2FAMADoc%2FHOD.xml-H-480.940.xmi, http://www.usp.org/sites/default/files/usp/document/our-work/healthcare-quality-safety/general-chapter-800.pdf, https://www.osha.gov/SLTC/hazardousdrugs/controlling_occex_hazardousdrugs.html, https://www.governing.com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational.html, https://healthpolicy.duke.edu/events/drug-shortage-task-force, https://www.ashp.org/news/2018/09/19/summit-on-drug-shortages-to-examine-impact-on-national-security-and-health-care-infrastructure, http://nationalacademies.org/hmd/Reports/2018/medical-product-shortages-during-disasters-brief.aspx, https://www.bloomberg.com/news/features/2019-01-29/america-s-love-affair-with-cheap-drugs-has-a-hidden-cost, https://www.who.int/medicines/publications/essentialmedicines/en/, https://voxeu.org/article/cancer-drug-prices-rise-no-end-sight, https://www.forbes.com/sites/joshuacohen/2018/06/20/whats-holding-back-market-uptake-of-biosimilars/#2282394c691a, https://www.biosimilarsip.com/2019/05/07/how-the-u-s-compares-to-europe-on-biosimilar-approvals-and-products-in-the-pipeline-4/, https://www.drugchannels.net/2019/04/the-specialty-pharmacy-boom-our.html, https://www.drugchannels.net/2019/04/the-top-15-specialty-pharmacies-of-2018.html, https://www.pharmacist.com/article/kentucky-pharmacists-have-new-authorities-improve-patient-public-health, https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/health-insurance-coverage-eight-years-after-aca, https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/employers-adjust-health-benefits-for-2019.aspx, https://abcsrcm.com/healthcare-industry-consolidation-walmart-humana-merger-medicare-advantage-plans/, https://medcitynews.com/2016/06/boeing-and-memorialcare-contract/, https://www.nytimes.com/2019/07/31/health/medicare-insurance.html, https://www.youtube.com/watch?v=Pc7EVXnF2aI, https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model, Receive exclusive offers and updates from Oxford Academic, New England (Maine, New Hampshire, Vermont, Massachusetts, 
Rhode Island, Connecticut), Mid-Atlantic (Delaware, New York, New Jersey, Pennsylvania), South Atlantic (Maryland, District of Columbia, Virginia, West Virginia, 
North Carolina, South Carolina, Georgia, Florida), Southeast (Kentucky, Tennessee, Alabama, Mississippi), Great Lakes (Ohio, Indiana, Illinois, Michigan, Wisconsin), Western Plains (Minnesota, Iowa, Missouri, North Dakota, South Dakota, 
Nebraska, Kansas), Middle South (Arkansas, Louisiana, Oklahoma, Texas), Mountain (Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada), Pacific (Washington, Oregon, California, Alaska, Hawaii), Copyright © 2020 American Society of Health-System Pharmacists. Similarly, pharmacologic effects of medical cannabis include the potential for adverse effects and drug interactions and will be more common with increased use. As public concern and public health risks grow with a resurgence of diseases previously eradicated by vaccines, this represents an opportunity for the profession. Health Care Planning & Evaluation Bruce Carruthers September 6, 2010 In business there are strategies that need to be fulfilled. The chief goals of strategic planning are as follows: Review the Current Issues. While large health systems with the capability to achieve high volume, as well as health systems with access to 340B pricing, will have fewer challenges, many SPs will struggle to be profitable. Product formulations and the associated active components of medical cannabis are not uniform, with resultant variability and unpredictability of response. The Pharmacy Forecast could not be created without the contributions of the report editor, founding editor, members of the Advisory Committee, Forecast Panelists who responded to the forecast survey, and chapter authors. ASCO Author Services 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.
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