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. 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. While staff with certain conditions (e.g., pregnancy) may request adjustments to their job responsibilities to avoid exposure, health systems should have policies and procedures that protect all staff from exposure to hazardous drugs. Conquer Cancer Foundation 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). A strategic plan is a tool that moves your practice toward a goal you have set. 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. These results are interesting, but simply disclosing prices will have little effect on accessibility to medications. The rise of violence, particularly gun violence, in the United States, as well as increasing risks associated with the opioid crisis, make pharmacy departments particularly vulnerable. 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? 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. Acute care pharmacists should document discharge summaries for community and ambulatory care pharmacists, paralleling physician documentation in EHRs, to make this process efficient. As in the past, survey respondents—Forecast Panelists (FPs) —were selected by ASHP staff after nomination by the leaders of the ASHP sections. Leverage the unique skill mix of pharmacy leaders by seeking leadership roles outside pharmacy (taking on other departments, institution-wide committees, etc.) 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. 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). 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?”. William A. Zellmer, B.S.Pharm., M.P.H., President, Pharmacy Foresight Consulting, Bethesda, MD. Journal for Nurses in Professional Development: 11/12 2017 - Volume 33 - Issue 6 - p 318-319 Healthcare has been remarkably resistant to reform. They want to know where your organization is headed and the steps it takes to get there. These teams should be incentivized to establish partnership outside of the health system as well, such as collaboration with postacute care facilities. 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. Actively participate in discussions around legislation that decreases the cost of medications and ties the cost to the value each medication provides. 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. 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. The size of the Forecast Panel in 2019 was deliberately increased in an effort to capture opinions from a wider range of pharmacy leaders than in past Forecasts, and the size of the Forecast Panel remained large this year. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. 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. In early 2018, in the midst of the flu season, basic i.v. Enter words / phrases / DOI / ISBN / authors / keywords / etc. Your comment will be reviewed and published at the journal's discretion. 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?”. Most drug shortages are caused by quality and manufacturing problems at the factory, which presumably will continue to occur in production facilities employed by new supply chain entities. 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. Engage in organizational dialog around meaningful quality metrics, lead the development and reporting of data most applicable to the patient populations treated and services provided at your institution, and actively pursue research around the relevance of specific metrics. A total of 325 FPs were recruited to complete the forecast survey. 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. Adding to a pharmacy leader’s portfolio of responsibility creates opportunities for sharing experience and resources across multiple departments. More than 30 years ago, the term patient-centered care was coined to shift the focus of healthcare providers and health systems from diseases back to patients, and a movement was born.1 Concepts regarding patient activation (knowledge, skills, and confidence in managing one’s own health) and codesigned care are emerging to emphasize a higher level of integration of patient beliefs, values, and preferences in clinical decision-making at both the bedside and in health policy.2–4 As the pharmacy enterprise expands across the continuum of care, there is opportunity for pharmacists to lead the way in establishing new patient-centered care models.5. Rather than being rewarded for high volume of medication use, departments will be judged on their ability to ensure appropriate medication use that reduces total cost of care (by shortening length of stay, reducing hospital readmission, etc.). (The Black Swan). White, M.S., FASHP, (Ret.) Healthcare Executive, Eden Prairie, MN. OSHA advocates for approaches using the principle of ALARA (as low as reasonably achievable) to minimize exposure risk, and it is this benchmark that is reflected in the 2019 American Society of Clinical Oncology standards.6. Address correspondence to Dr. Ginsburg (email@example.com). 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. As specialty pharmacy and ambulatory care practice continues to expand in health systems, there is a greater need for enterprise-wide communication among pharmacists providing care across these settings. Strategic Planning for a Health Care Facility. Through engagement with state and national professional associations, support legislative and regulatory efforts aimed at preventing industry strategies (such as patent manipulation) for delaying the market entry of biosimilars and conventional generics. Address correspondence to Dr. Fox (Erin.Fox@hsc.utah.edu). Multiple shortage meetings held in 2018 provided recommendations for ensuring the adequacy of prescription drug supply.1–3 Notably, after one such meeting, the National Academy of Sciences recommended an evaluation of the adequacy of prescription drug supply as a matter of national security,2 and a final report on the work of the Food and Drug Administration’s Drug Shortages Task Force is due to Congress by the end of 2019. Pub. Address correspondence to Mr. Zellmer (firstname.lastname@example.org). For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Ensure that action plans exist to care for those patients (such as protocols to allow pharmacists to switch patients to more affordable products). (June 20. 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. bBased on 2018 U.S. Census population data (estimated). Reviewers 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. 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 (. degree (Figure 2, item 6). This is inconsistent with national trends and attention to the preparation of these medications. 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). Strategic decision making is needed now more than ever for success in oncology practice. Forecasting future events is an important exercise that can help leaders create well-informed strategic plans. Recent proposals of “Medicare for All” as one universal coverage model (which could lead to a single-payer system) have been embraced by some but panned by others.7 A surprising 30% of FPs felt that universal coverage is likely, while most felt it is unlikely and 34% felt it is very unlikely (Figure 7, item 5). 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. Cancer.Net, ASCO.org In one, a majority (76%) of FPs agreed that new performance metrics will be based on evidence of improved patient outcomes (Figure 4, item 2), and a similar majority (76%) agreed that mandates related to handling of hazardous products will be based on evidence of lower risk to patients and healthcare workers (Figure 4, item 3). 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. 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. September 21, 2016. It examines obstacles that sit between where your healthcare organization is and where it should be. (Healthcare Marketplace). Develop and implement improved documentation systems that discretely capture pharmacy impact and enable analysis of the value of pharmacy services. 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. ASCO Author Services Although some colleges and schools have established various dual degree programs that leverage existing curricular resources and provide substantial benefits to graduates, a joint Pharm.D./P.A. TAPUR Study. 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. Starting a business or health care organization we need to use strategy planning. (Observer). As another election cycle begins, many stakeholders are discussing ways to reduce drug prices. Despite increasing policymaker awareness, the outlook for the supply of prescription drugs is unlikely to improve over the next several years. Dr. Fox is also a member of the AJHP editorial board. (Evidence-based Pharmacy Practice). Health-system pharmacy leaders possess skills that have often made them candidates for positions outside pharmacy. To prepare FPs to answer survey questions in this section, we introduced the concept of the black swan and provided several hypothetical (but potential) black swan events as examples. 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. Of course, the effort required to achieve recognition will also improve the care provided to patients—achieving that objective is essential. 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. 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. “Our patients are at the center of all we do. As value-based reimbursement becomes more common, it is also possible that initiatives emphasizing continuity of care may make health-system SPs attractive to insurers contracting for the total care of select patients. DOI: 10.1200/JOP.0936501 Journal of Oncology Practice 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. The 2020 Pharmacy Forecast is intended to assist with strategic planning efforts by health-system leaders. 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. 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 ASCO Post or Pharm.D./M.H.A. Strategic planning is a fundamental component of organizational management and decision making in public, private, and nonprofit organizations. 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. However, the definition of a strategic plan differs among different people, according to … Given the current evidence gaps, these results were unexpected. Similarly, pharmacologic effects of medical cannabis include the potential for adverse effects and drug interactions and will be more common with increased use. program would be challenging to offer and unlikely to provide substantial payoff for graduates. 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. In these scenarios, if FPs believed that individuals or entities tend to be well equipped for responding to black swans, the charts would be skewed to the right (i.e., toward 100% resilience in dealing with an unpredicted disruptive event). Product formulations and the associated active components of medical cannabis are not uniform, with resultant variability and unpredictability of response. The editorial staff of AJHP has provided substantial support for this publication, and we appreciate their assistance. 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. One of the most common pharmacy services offered through retail clinics is vaccinations. However, skills provided in joint Pharm.D./M.B.A. 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. 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. Michael J. Melby, B.S.Pharm., M.S., Director of Innovation and Activation, Indiana University Health, Indianapolis, IN. Schumock GT, Stubbings J, Hoffman JM 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.
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