The cost and effort associated with achieving designation will be difficult to justify while the benefits of designation are uncertain. While many FPs agreed that some employers will bypass traditional insurers and will contract directly with specific health systems, 36% felt it is unlikely (Figure 7, item 3). William A. Zellmer, B.S.Pharm., M.P.H., President, Pharmacy Foresight Consulting, Bethesda, MD. and physician assistant (P.A.) 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 the absence of federal action, states will work to accomplish as much as possible under the constraints they face. 3 The evolution of the 21st century organization. Address correspondence to Ms. White (email@example.com). 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. 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. Both your employees and stakeholders want to ensure that your organization will have a long-lasting future. 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. The mixed survey response is likely a reflection of the complexity that would be involved in establishing such a recognition program. This edition of the report differs from the first 7 editions, just as each previous version differed from earlier versions. Everyone’s voice matters. 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. 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. They were asked to provide a top-of-mind response regarding the likelihood of those conditions being very likely, somewhat likely, somewhat unlikely, or very unlikely to occur. 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. 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. Dr. Fox is also a member of the AJHP editorial board. Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. 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). Many pharmacy departments are organized by setting of care. Currently, there are no uniform education and training requirements for technicians. fluids such as normal saline became unavailable. Journal for Nurses in Professional Development: 11/12 2017 - Volume 33 - Issue 6 - p 318-319 The Foundation is also grateful to Omnicell for their support of the Zilz fund, which has made the Pharmacy Forecast possible. In the pharmacy department’s planning process, increase the relative attention given to long-term strategic issues (versus near-term operational issues); use annual Pharmacy Forecast reports to stimulate this shift. 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. fluids. Invest in the collection of PRO data using validated questionnaires, and make the information readily retrievable in the EHR for frontline staff. Many of the FPs hold the title of chief pharmacy officer or director of pharmacy (13% and 16% of FPs, respectively). Due to regulatory barriers and the lack of standardization in data sources within electronic health records2, such data are rare in healthcare, and few health systems will have sufficient reliable data to effectively inform advanced computing applications. 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, Austin, TX. According to U.S. News & World Report, physician assistants made a median salary of $104,860 in 2017; the top quartile made $124,200 that year, while the lowest quartile made $87,980.4. JCO Precision Oncology, ASCO Educational Book 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). Contact Us Of course, the effort required to achieve recognition will also improve the care provided to patients—achieving that objective is essential. An audio interview that supplements the information in this article will be available at www.ajhpvoices.org. The members of the Pharmacy Forecast Advisory Committee were instrumental in considering hundreds of factors that may influence the future of health-system pharmacy and distilling those ideas into a coherent survey. When signing local drug acquisition contracts, insist on disclosure of the source and site of manufacture, and ensure that contracts signed by group purchasing organizations on behalf of health systems also include disclosure. in strategic management of the organization to organizational growth. Interpretation of genetic results can be challenging, and an investment in infrastructure must be made so that appropriate interpretations are available in real time and errors are avoided. Bruce E. Scott, B.S.Pharm., M.S., FASHP, (Ret.) The importance of pursuing diversity in the pharmacy workforce—a critical objective that requires deliberate strategic planning for health systems—is also discussed in that section. 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. 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. DOI: 10.1200/JOP.0936501 Journal of Oncology Practice Dr. Knoer and Mr. Zellmer are contributing editors of AJHP. They want to know where your organization is headed and the steps it takes to get there. 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. It is also important to note that not all violence is physical—verbal and emotional abuse must also be recognized and addressed. 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). 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. However, they quickly learned that 80 pharmaceutical manufacturing facilities were concentrated in Puerto Rico. Health systems should collaborate with colleges and schools of pharmacy to develop a range of training options for pharmacists to ensure an adequate supply of staff capable of meeting the future needs of the healthcare system. 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. 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. 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. However, the increasing cost of medications is an ongoing issue affecting patients and payers, and government action is required to capitalize on saving opportunities presented by lower-cost agents. (Patient-Centered Care). Currently, almost all of the APMs involve c… These teams should be incentivized to establish partnership outside of the health system as well, such as collaboration with postacute care facilities. Develop and implement new technology in telemedicine to improve access to the care of pharmacists in medically underserved communities. 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). The term relates to the centuries-old assumption that all swans were white, which held until a black swan was discovered in 1697, forever changing the assumption about the color of swans. The stability of the supply chain is of critical importance, and recommendations for focused strategic planning are provided. Cancer.Net, ASCO.org Those organizations involved in education or training should consider the use of the Pharmacy Forecast as a teaching tool. 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. Similarly, pharmacologic effects of medical cannabis include the potential for adverse effects and drug interactions and will be more common with increased use. Ensure that action plans exist to care for those patients (such as protocols to allow pharmacists to switch patients to more affordable products). Scott Knoer, M.S., Pharm.D., FASHP, Chief Pharmacy Officer, Cleveland Clinic, Cleveland, OH. Collaboration with clinical informatics colleagues is needed to address current data shortfalls. 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. For permissions, please e-mail: firstname.lastname@example.org. 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. 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. Today, in a letter to its 75,000 employees, Partners HealthCare President and CEO Anne Klibanski, MD unveiled a five-year strategic plan and announced plans for rebranding the health care system, which serves more than 1.5 million patients and receives nearly $2 billion in research funding annually. 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. Drug shortages are not improving. 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. In a continuing discussion of the future of pharmacy education and pharmacy workforce issues, Diane Ginsburg and Katie Pritchett provide a section exploring a number of challenges that will face health-system pharmacy leaders in the coming years. Mark A. Lantzy, Senior Vice President and Chief Information Officer, Indiana University Health, and President, Indiana University Health Plans, Indianapolis, IN. 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. 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. For the survey items in this domain, Forecast Panelists (FPs) were asked to review a definition of black swans and then estimate on a sliding scale the percentage of individuals or entities in their region that embody a certain characteristic. As another election cycle begins, many stakeholders are discussing ways to reduce drug prices. A majority of FPs felt health systems will have a large portion of their revenue at risk in the future (Figure 7, item 4). 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. 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. Those changes are unlikely in the near future. 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! 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. The continuing trend toward value-based reimbursement models—paying for performance rather than for volume of care delivered—places pharmacy departments in a particularly vulnerable position. A healthcare organization's strategic plan is designed to identify the necessary actions needed to reach the objectives of the organization. Two topics that are often included in the Pharmacy Forecast—the healthcare marketplace and healthcare reform—also appear in this year’s edition. In the 2020 survey, every region was represented by a minimum of 19 FP respondents (up from a minimum of 16 in 2019). They don’t need long recitations of bromides. The Foundation is indebted to those individuals who have helped make the 2020 edition a success. Healthcare organizations today are facing a series of problems due to two main factors: increasing difficulty in satisfying a progressively more ‘aware’ and demanding user, and the need to change their internal organization to keep pace with the very rapid changes taking place in technology and approach. When compared to the distribution of survey respondents in 2019, we achieved improved balance in both the percentage of responses coming from each region and the response rate per million population in this year’s survey. Address correspondence to Dr. Nesbit (email@example.com). Responses were received from 283 (an 87.1% response rate, up slightly from the 85.4% response rate in 2019). 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. 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. 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. Pharmacists with P.A. Strategic plans should be reviewed frequently, allowing for tactical adjustments in course over time as trends (those discussed in this report and others that were not predicted) emerge. This process is particularly valuable when addressing phenomena that are not well suited to quantitative predictive methods. Michael J. Melby, B.S.Pharm., M.S., Director of Innovation and Activation, Indiana University Health, Indianapolis, IN. The duties a technician can perform will be nonjudgmental; however, they will continue to take on additional tasks that will necessitate additional education, training, and credentials. 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.
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