Our focus is on larger-scale trends, and our goal is to look beyond ethereal whims of politics and practice in an attempt to address deeper patterns that will impact us over months and years. 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. 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. program would be challenging to offer and unlikely to provide substantial payoff for graduates. The evolution of the 21st century organization. All rights reserved. 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?”. Health insurance coverage eight years after the ACA: fewer uninsured Americans and shorter coverage gaps, but more underinsured (February 7. 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. 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. Despite the constancy of change in the healthcare marketplace, the demand for patient-centered care shows no signs of abating. Given the complexity, uncertainty, and pace of change in healthcare today, strategic planning must be a continuous process. 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?”, Nearly all states currently enable collaborative drug therapy management by pharmacists in some form or fashion along a continuum from most restrictive to least restrictive (including independent prescribing authority). Collaboration with clinical informatics colleagues is needed to address current data shortfalls. 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. Onasemnogene abeparvovec-xioi (Zolgensma, AveXis). However, they quickly learned that 80 pharmaceutical manufacturing facilities were concentrated in Puerto Rico. 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. or Pharm.D./M.H.A. Edney A. America’s love affair with cheap drugs has a hidden cost (January 29. Forecasting future events is an important exercise that can help leaders create well-informed strategic plans. Of course, the effort required to achieve recognition will also improve the care provided to patients—achieving that objective is essential. : Erin R. Fox, Pharm.D., BCPS, FASHP, Senior Director, Drug Information and Support Services, University of Utah Health, and Adjunct Associate Professor, University of Utah College of Pharmacy, Salt Lake City, UT. Establish methods for identifying patients at risk for negative outcomes due to lack of access to essential medications or exposure to substandard-quality medications. 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. Fifty-four percent of FPs felt that such federal action will occur in the future (Figure 5, item 2). (Pharmacy Workforce). Whether or not a fully realized single-payer system is achieved, broadening access to efficient care—particularly outside the acute care setting—is essential. 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. Â© 2020 MJH Life Sciences and Managed Healthcare Executive. 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. Remote introductory pharmacy practice experiences focused on veterans prescribed chronic opioid therapy, Evaluation of an opioid risk mitigation initiative for veterans undergoing hip or knee arthroplasty at San Francisco Veterans Affairs Heath Care System, In the midst of an opioid epidemic: Pharmacists on the frontline of substance use disorder treatment, Management of type 2 diabetes with oral semaglutide: Practical guidance for pharmacists, To crush or not to crush: A brief review of novel tablets and capsules prepared from nanocrystal and amorphous solid dispersion technologies, 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,
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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. 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. 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). As was recommended in the 2019 Pharmacy Forecast, pharmacists must have the skills to implement care that fosters shared decision-making to improve patient outcomes.8 It is also important for training programs to include exposure to such care models and skills. As another election cycle begins, many stakeholders are discussing ways to reduce drug prices. Pharmacies must comply with certain track-and-trace requirements in 2020, FDA says. They used this role to âmanageâ the cost of the pharmacy benefit while simultaneously creating new ways to create profits for themselves. Although many healthcare institutions have developed excellent operational plans for responding to local natural disasters, accidents, or terrorism,2 that may not prepare them for an effective response to a black swan event, which depends more on flexibility and team culture than a written plan. A forward-thinking healthcare executive should have a process to scan the industry for innovative applications for consumer-centered healthcare and be willing to make incremental strategic investments that can benefit their members. Employers, in an effort to reduce costs and improve outcomes, will continue contracting directly with providers. Product formulations and the associated active components of medical cannabis are not uniform, with resultant variability and unpredictability of response. The remainder of FPs included leaders and practitioners at varying levels and with varying titles. 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. Partner with postacute care providers to enhance communication and care coordination between clinical teams. Develop and implement improved documentation systems that discretely capture pharmacy impact and enable analysis of the value of pharmacy services. 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. Fifty-seven percent of FPs indicated they believe it is likely that colleges and schools of pharmacy will offer a joint doctor of pharmacy (Pharm.D.) It will be difficult for health-system SPs to compete with market-dominating SPs. 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. Pharmacy leaders will need to be creative and identify ways to leverage the expertise of their staff and their existing departmental resources in new programs that address unmet patient needs. 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? Pharmacy Tech Topics™ accredits at least one hour of pharmacy law and one hour of patient safety CPE credit in alternating years. Responses were received from 283 (an 87.1% response rate, up slightly from the 85.4% response rate in 2019). In a section on patient-centered care, Meghan Swarthout and Caleb Alexander describe a wide range of trends that extend the discussion on this topic provided in the 2019 Pharmacy Forecast. 8 DEC 2020 15:33. Oxford University Press is a department of the University of Oxford. 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. Pharmacy is responsible for preparing and distributing some hazardous products. 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. Pharmacists’ acknowledged ability to drive efficiency will allow them to contribute substantially to their organizations. 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. 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. Home » 2020 Topics & Objectives » 2020 Topics and Objectives – Objectives A–Z Topics & Objectives Each topic area includes an overview, objectives and data, * … 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. 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. The editorial staff of AJHP has provided substantial support for this publication, and we appreciate their assistance. 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. 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. Nominations were limited to individuals known to have expertise in health-system pharmacy, knowledge of trends and new developments in the field, and the ability to think analytically about the future. Health-system leaders must identify and engage with partners in other health systems and educational institutions to provide accredited technician education and training programs that will ensure the availability of an increasingly competent technician workforce. Members have told us that administrative third party payment burdens, additional training, more and new technology, better equipped pharmacy technicians, and additional manpower are … However, research topics still need to do enough research and gather a lot of data and facts from reliable sources in … Using information technology can enable timely communication. 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. Assure the development of pharmacist expertise related to genomic testing, creating infrastructure and developing policies and practices that address the appropriate clinical and ethical use and interpretation of such testing. 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. However, price controls for a few specific products will not have a meaningful impact on the overall challenge of the extraordinarily high cost of medications. Forecast Panelists’ responses to survey items regarding preparedness to respond to black swan events. Key performance metrics are used to track productivity, assure quality, and identify opportunities for improvement. As senior leadership teams become smaller in order to reduce labor costs, pharmacy leaders may be asked to take on additional responsibilities. These tools should not be implemented until there is a clear plan for how the information will be used, and careful consideration should be given to the overall volume of questionnaires posed so as to avoid patient frustration and disengagement. 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. A video interview with Michael Haydock about the latest news on the COVID-19 vaccine race. 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. (The Black Swan). Capital investments beyond what most health systems can invest will also continue. 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. Individuals in remote locations can fill prescriptions that can then be mailed to their location. 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). Given the current evidence gaps, these results were unexpected. Approximately half of FPs believe that a publicly accessible hospital charge master will provide value to consumers (Figure 6, item 5). The top pharmacy trends for 2020 and the year that was 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. Most FPs (58%) described their practice setting as a teaching hospital or health system, while 15% of FPs were from nonteaching hospitals or health systems and 13% from academia (essentially unchanged from 2019). Currently, there are no uniform education and training requirements for technicians. Periodically lead “what if” discussions that probe how the pharmacy team would respond to a particular black swan event. 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. 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. 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. 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. L. No. The authors have declared no potential conflicts of interest. Dr. Swarthout has declared no potential conflicts of interest. Acute care pharmacists should document discharge summaries for community and ambulatory care pharmacists, paralleling physician documentation in EHRs, to make this process efficient. As public concern and public health risks grow with a resurgence of diseases previously eradicated by vaccines, this represents an opportunity for the profession. 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. FPs were divided as to whether health systems would offer an ASHP/ACPE-accredited technician education program (Figure 2, item 3). The stability of the supply chain is of critical importance, and recommendations for focused strategic planning are provided. Aston University first in UK to subscribe to Pharmacy Knowledge . 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. products, necessitating a specially trained and certified pharmacy workforce. Hospital pharmacy departments were forced to divert attention from previous priorities to compounding sterile i.v. 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. White, M.S., FASHP, (Ret.) 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. Collaborate with public health officials to engage populations increasingly reluctant to accept vaccines, and deploy tactics that promote dialogue and education to optimize vaccination rates. About the Pharma 2020 series. As companies like Amazon impact the drug distribution model for pharmacy and reshape the consumer experience in buying prescription drugs, pharmacy needs to invent care models to remain relevant. 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. Serving as the middle man between drug companies and pharmacies, PBMs have also amassed large databases of pharmacy claims data to analyze drug utilization and track financial performance. 3 DEC 2020 16:23. It is also important to note that not all violence is physical—verbal and emotional abuse must also be recognized and addressed. European markets have realized significant savings through the use of biosimilars, with certain biosimilars capturing 90% market share in some European countries, resulting in 70% cost reductions relative to originator product costs.2 The European Medicines Agency has 53 products on its approved list of biosimilars, with each European Union country controlling how these agents are used within its borders.3 By comparison, within the United States there are 19 products approved by the Food and Drug Administration, and only 7 are marketed. Legislative and regulatory efforts may require certification for personnel involved in sterile product compounding. A majority of FPs indicated they believe this is a likely occurrence in many departments (Figure 3, item 3). The purpose of this report is to encourage and support active, deliberate strategic planning in hospitals and health systems. While the intent of pricing transparency is commendable, challenges in establishing a common charge master format and standardizing pricing information make it unlikely that the current proposals will provide meaningful information that could assist patients in making better decisions regarding their care. Healthcare Executive, Eden Prairie, MN. Substance Use … Eric Maroyka, Senior Director, Center on Pharmacy Practice Advancement sits down with Patricia C. Kienle, MPA, BCSCP, FASHP, and Michael Ganio, Senior Director, Pharmacy Practice and Quality to discuss aspects of the draft The National Institute for Occupational Safety and Health (NIOSH) List of Hazardous Drugs in Healthcare Settings 2020. Within each section of this report, the results of each survey question are summarized in detail. Develop and implement new technology in telemedicine to improve access to the care of pharmacists in medically underserved communities. We welcome your comments on this new edition of the Pharmacy Forecast. It is likely that more states will pursue the less restrictive approaches in the years ahead. A critical requirement for successfully creating crowd-based knowledge is establishing a systematic method of combining individual beliefs into a collective opinion—the Pharmacy Forecast uses a survey of carefully selected pharmacy leaders to derive our environmental scan. Certification programs of the Board of Pharmacy Specialties (BPS) and the Pharmacy Technician Certification Board (PTCB) are now available for practitioner certification.1,2 The Joint Commission (TJC) has developed a Medication Compounding Certification program to assess compliance with standards for preparing sterile and nonsterile products.3 Michigan became the first state to require certification by TJC, with over 75 hospitals certified.3 This certification may become the best practice for compounding sterile i.v. 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