ABSTRACTS FROM THE FORUM ON ADVANCES IN HEALTHCARE MANAGEMENT RESEARCH: The Contribution of Physician–System Integrating Structure to Health System Success Less Journal of Healthcare Management. Congressional hearings featuring parents of children who have died due to insulin rationing resulted in commitments to support the launch of an authorized generic for insulin, which may lead to more affordable care. 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. Artificial intelligence (AI) and other advanced computing technologies are growing in presence and impact throughout healthcare.1 It is plausible that multiple pharmacy-related tasks now fulfilled by personnel may soon be accomplished by AI, but in order for effective AI systems to be developed and applied, a significant body of high-quality data related to the task to be automated must be available. 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). Address correspondence to Dr. Fox (Erin.Fox@hsc.utah.edu). The concept of a “black swan” a—a rare event (widely deemed improbable) that has massive consequences—was popularized by a 2007 book (updated in 2010) by Taleb.1 After a black swan event, explanations often emerge that make the event seem predictable (although few had seen it coming). Lee C. Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, Chief Efficiency Officer, UK HealthCare, and Professor of Medicine and Pharmacy, University of Kentucky, Lexington, KY. Boeing bypasses traditional health insurance model in contract with MemorialCare health system: a sign of things to come? and physician assistant (P.A.) Hence, it is time for a revolution… As the role of the pharmacist continues to emphasize cognitive services and include fewer distributive tasks, a higher-educated and higher-trained technician force will be necessary to support pharmacists performing clinical functions. Search for other works by this author on: Ambulatory and Transitions of Care Services, Department of Pharmacy, Johns Hopkins Health System, Address correspondence to Dr. Swarthout (, Professor of Epidemiology and Medicine, Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Diane B Ginsburg, B.S.Pharm., M.S., Ph.D., FASHP, Clinical Professor and Associate Dean for Healthcare Partnerships, Pharmacy Practice Division, The University of Texas at Austin College of Pharmacy, McCombs School of Business, The University of Texas at Austin College of Pharmacy, Associate Vice President and Chief Pharmacy Officer, Senior Vice President of Operations, Wake Forest Baptist Health, Director – Pharmacy Patient Care Services, The Johns Hopkins Health System, William Greene, B.S.Pharm., Pharm.D., BCPS, FASHP, FCCP, Chief Pharmaceutical Officer and Member, Pharmaceutical Department, St. Jude Children’s Research Hospital, Senior Director, Adjunct Associate Professor, Drug Information and Support Services, University of Utah Health, Department of Markets, Public Policy and Law, Questrom School of Business, Boston University, Director of Innovation and Activation, Indiana University Health, Senior Vice President and Chief Information Officer, Indiana University Health, and President, Indiana University Health Plans, James M Hoffman, Pharm.D., M.S., BCPS, FASHP, Chief Patient Safety Officer and Associate Member, Pharmaceutical Sciences, St. Jude Children’s Research Hospital, The black swan—the impact of the highly improbable, STRATEGIC RECOMMENDATIONS FOR PRACTICE LEADERS, Shared decision making—the pinnacle of patient-centered care, Patient Protection and Affordable Care Act. 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. (Drivers of Healthcare Reform). For permissions, please e-mail: journals.permissions@oup.com. As public concern and public health risks grow with a resurgence of diseases previously eradicated by vaccines, this represents an opportunity for the profession. Several emerging issues facing health-system pharmacy leaders are addressed by Sara White, Jen Tryon, and Conrad Emmerich in a specific section devoted to leadership. This year, we chose to explore a facet of strategic planning dealing with our ability to respond to unexpected, unpredictable events known as “black swans.” 2 As you will read in the section of the Pharmacy Forecast written by Bill Zellmer, Scott Knoer, and James Hoffman, black swan events pose opportunities and threats to health systems. FPs indicated that Haven will reduce healthcare spending for the companies’ employees (Figure 7, item 2), but it is unclear if those savings will be realized more widely. JCO Oncology Practice 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 … Address correspondence to Mr. Zellmer (wzellmer@msn.com). These new ventures seek to address shortages largely by outsourcing additional production to contract manufactures. Forecast Panelists’ responses to survey items regarding preparedness to respond to black swan events. Genomic testing is rapidly advancing into patient care as technology improves, new knowledge is applied, and testing cost decreases. A cardiology department, a hemodynamic unit, or an electrophysiology unit can be an appropriate level, as long as their plans align with other plans … The introduction of biosimilars and the speed by which generic drug products are introduced into the market are 2 factors influencing the cost trends of medications.1 Interestingly, 91% of Forecast Panelists (FPs) indicated they believe that biosimilars will achieve 25% of the market share in the next 5 years (Figure 6, item 1). 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. Involving an institutional patient and family advisory council to guide this process can help mitigate this risk. Employers may offer financial incentives to employees who voluntarily choose preferred providers they have under direct contract, but based on experience with high-deductible insurance plans, financial incentives are not terribly effective in driving employees to more efficient care options. The Foundation is also grateful to Omnicell for their support of the Zilz fund, which has made the Pharmacy Forecast possible. 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. 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. They were asked to base their response on their firsthand knowledge of current conditions in their region, not based on their understanding of national circumstances. Michael Melby and Mark Lantzy contribute a discussion of healthcare reform challenges that will face health systems in the coming years. Increasing the amount of discretely measured and documented data in electronic health records will require extra work by pharmacists (and other pharmacy staff) and workflow changes that will pose challenges to leaders. 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. As in the past, survey respondents—Forecast Panelists (FPs) —were selected by ASHP staff after nomination by the leaders of the ASHP sections. 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. 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. Why ‘Strategic Plans’ Are Rarely Strategic—or Effective Effective managers can list their goals on a note card. 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. The results are discussed and key strategic recommendations are provided to stimulate strategic planning by pharmacy leaders. A different type of black swan hit hospitals in 2017 with the arrival and rapid adoption of 2 CAR-T therapies for various leukemias and lymphomas in adults and children.b At a cost of up to $475,000 per patient, and with a lag in insurance coverage and an absence of alternative therapies, many hospitals had to initially absorb this expense.c In 2019, a gene therapy for spinal muscular atrophy in children less than 2 years oldd hit the market at a cost of $2 million for a single patient—an astonishing figure that few institutions and payers were prepared for. Bruce E. Scott, B.S.Pharm., M.S., FASHP, (Ret.) Pharmacy practice leaders can enhance the effectiveness of their planning process by considering proactively how to optimize their department’s resiliency when confronted with unanticipated events that have enormous positive or negative consequences. Routine communication and collaboration on quality improvement projects will yield efficiencies, helping to financially justify the added time needed for this work. 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. As in the past, we have specifically avoided discussions of issues that are prone to dynamic change on a day-by-day basis, such as emerging trends in medication shortages. 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! degree (Figure 2, item 6). This process is particularly valuable when addressing phenomena that are not well suited to quantitative predictive methods. More than 181 million individuals currently have employer-sponsored health insurance in the United States.2 At an average cost of nearly $15,000 per employee per year, employers are highly motivated to reduce their spending on healthcare.3 Haven, a joint venture between Amazon, Berkshire Hathaway, and JPMorgan Chase, is trying to accomplish this goal by creating efficiencies of scale and leveraging the companies’ resources to diminish the role of supply chain and fiscal intermediaries such as pharmacy benefit managers (PBMs), wholesalers, and group purchasing organizations (GPOs). Given the complexity, uncertainty, and pace of change in healthcare today, strategic planning must be a continuous process. 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. Most FPs (63%) believed that in many health systems, departments other than pharmacy will have primary responsibility for the management of these treatments (Figure 4, item 5). Given the challenge of achieving consensus on which drugs should be included on such a list, this result was surprising. Dr. Knoer and Mr. Zellmer are contributing editors of AJHP. About Dr. Conti is an unpaid special consultant to FDA’s Office of Generic Drugs.The authors have declared no other potential conflicts of interest. The Pharmacy Forecast has been developed to provide guidance to anyone participating in strategic planning activities and it is recommended that the report be reviewed by all involved. Heymach J, Krilov L, Alberg A et al. programs, such as the ability to develop and implement new clinical programs, may be of more value. Placing multiple departments under the leadership of one executive also makes it easier to reduce silo budgeting by identifying and implementing interventions that may increase cost in one department while reducing cost to a greater degree in another (for example, using a high-cost medication to reduce blood utilization, resulting in lower total cost of care). As senior leadership teams become smaller in order to reduce labor costs, pharmacy leaders may be asked to take on additional responsibilities. It is intended to stimulate thinking and discussion, providing a starting point for individuals and teams who wish to proactively position themselves and their teams and departments for potential future events and trends rather than be reactive to those things that occur. Acute care pharmacists should document discharge summaries for community and ambulatory care pharmacists, paralleling physician documentation in EHRs, to make this process efficient. 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. Those changes are unlikely in the near future. 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. 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. The combination of nontraditional residency training with graduate studies (e.g., executive M.B.A. degree programs) may also be attractive to pharmacists following a nontraditional career development path. 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. Collins SR, Bhupal HK, Doty MM. 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). It will be difficult for health-system SPs to compete with market-dominating SPs. Forecast Panelists (FPs) indicated great faith in the ability of states to make progress in healthcare reform where the federal government has failed (Figure 7, item 1). Identify and implement procedures that ensure that diversity is included as a component of the recruitment process for all pharmacy staff, including students, residents, technicians, pharmacists, and pharmacy leaders. ASCO Author Services Drug shortages are not improving. 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. The panel was carefully balanced across the census regions of the United States to reflect a representative national picture. Dr. Hoffman is a member of the AJHP editorial advisory board. Health-system pharmacy has turned to a wide range of entrepreneurial ventures to offset high labor costs and rising medication costs. Healthcare Executive, Eden Prairie, MN. 4-Star Rating, Doody’s Medical Reviews. This article presents the principles of strategic planning and outlines processes that your practice can adapt for short- or long-term planning. If you believe the predictions discussed in the Pharmacy Forecast are not correct, it follows that you have a different opinion of what the future holds or how future events will shape the healthcare system and the care we provide. Strategic planning often is done pre-event, based on previous experience and expertise. We turn to Todd Nesbit and Bill Greene for a discussion surrounding the role of evidence in a wide range of pharmacy practice areas. In the 2020 survey, every region was represented by a minimum of 19 FP respondents (up from a minimum of 16 in 2019). 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. Prioritize the development of entrepreneurial skills among pharmacy leaders to ensure that innovative programs meeting the needs of both patients and health systems are identified and implemented. Todd W. Nesbit, Pharm.D., M.B.A., FASHP, Director – Pharmacy Patient Care Services, The Johns Hopkins Health System, Baltimore, MD. Real action to improve competition, such as eliminating “pay for delay” deals and reforming drug patent laws to prevent “evergreening,” are needed to truly impact the problem. 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. 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. As another election cycle begins, many stakeholders are discussing ways to reduce drug prices. published online before print These results are interesting, but simply disclosing prices will have little effect on accessibility to medications. Many of the FPs hold the title of chief pharmacy officer or director of pharmacy (13% and 16% of FPs, respectively). 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. 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? It is interesting that while FPs seemed optimistic that SPs owned by health systems will show benefit over national providers, they overwhelmingly feel that their patients will be forced by their insurers to seek infusion care outside their own health systems (Figure 6, item 4). 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. Consideration must be given to patients’ time investment in answering these questions. The results for survey items 3 and 4 (Figure 8) are worrisome because they suggest that both health-system pharmacy departments and health systems as a whole tend not to have a strategic planning process that is well suited to dealing with black swans. 5, no. 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. Health-system pharmacy leaders possess skills that have often made them candidates for positions outside pharmacy. Your strategic plan should address the key issues, y… Develop and implement health system–based programs that respond to those same drivers. Conrad Emmerich, M.B.A., Senior Vice President of Operations, Wake Forest Baptist Health, Winston-Salem, NC. Effective planning in healthcare managementcan help you create clarity and improve communication. (Pharmacy Workforce). ASCO Career Center In pharmacy, diversity at every level of staffing must be a leadership focus. While it is possible that new supply chain entities will assist with some shortages, it is doubtful that they will have the capacity to address the hundreds of shortages that exist today. Advertisers, Journal of Clinical Oncology Develop a roadmap to engage patients and care teams in shared decision-making discussions prior to therapy plan development, including consideration of out-of-pocket costs. Identify and participate in programs that may improve the supply of essential medications, such as joining not-for-profit drug manufacturing consortiums, but plan to continue to invest in shortage management resources. Date have been country-specific and have not integrated different international and multi-level insights international multi-level. 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