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. Tisagenlecleucel (Kymriah, Novartis) and axicabtagene ciloleucel (Yescarta, Kite Pharma). Please check for further notifications by email. Pharmacy practitioners, on the other hand, were perceived by FPs as generally having difficulty in taking black swans in stride (Figure 8, item 2). Strategic planning includes all measures taken to provide a broad picture of what must be achieved and in which order, including how to organise a system capable of achieving the overall goals. 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. 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. 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. 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. While drug shortages had long been an issue, most pharmacists likely believed that the pharmaceutical supply chain was fundamentally secure. When done right, “a strategic map” will create the perfect ecosystem for sustained success by zeroing in on specific areas for action. In this industry especially, healthcare planning must take into account potential government policy changes, technological advancements and economic trends that could change an organization’s operations in a significant way. 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. Address correspondence to Mr. Melby (email@example.com). Studies to date have been country-specific and have not integrated different international and multi-level insights. Thank you for submitting a comment on this article. Many educators and residency preceptors use the report as part of coursework, seminars, or journal club sessions to help engage pharmacy trainees in thinking about the future of the profession they are preparing to enter. The strategic plan in healthcare acts as a compass to organizational success. 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). Those changes are unlikely in the near future. As public concern and public health risks grow with a resurgence of diseases previously eradicated by vaccines, this represents an opportunity for the profession. and physician assistant (P.A.) 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. 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. 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. However, the definition of a strategic plan differs among different people, according to … National pharmacy organizations will expand their membership to include technicians. While it is not possible to be “black swan proof,” it is possible to be “black swan robust”—with deliberate, consistent, and effective strategic planning, an individual, organization, or community can be better prepared to successfully respond when black swan events inevitably occur, and preparation for those events is an essential leadership challenge. Lead your institution to proactively develop data systems that support the development of validated AI applications, providing the opportunity to redeploy human resources to other unmet patient care needs. It is only through a continuous process that organizations can be responsive to changes that are sure to affect our profession, organizations, and patients. degree holder than a pharmacist without the ability to diagnose and prescribe. 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? The existing regulatory landscape frequently results in confusion for patients and conflicts for healthcare practitioners. The Pharmacy Forecast could not be created without the contributions of the report editor, founding editor, members of the Advisory Committee, Forecast Panelists who responded to the forecast survey, and chapter authors. State reforms have the potential to expand access, improve competition and patient choice, increase transparency of prices and performance, and reduce burdensome regulations, expanding opportunities for pharmacists. The term value is ubiquitous in discussions around healthcare expenditures but is rarely used to determine prices paid for drugs in the United States. 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. Subscribers Mark A. Lantzy, Senior Vice President and Chief Information Officer, Indiana University Health, and President, Indiana University Health Plans, Indianapolis, IN. Pharmacists with P.A. All past editions of the Pharmacy Forecast can be found on the ASHP Foundation website at http://www.ashpfoundation.org/pharmacyforecast. 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. Pharmacy is responsible for preparing and distributing some hazardous products. Conrad Emmerich, M.B.A., Senior Vice President of Operations, Wake Forest Baptist Health, Winston-Salem, NC. 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. (Drivers of Healthcare Reform). Pharmacists’ acknowledged ability to drive efficiency will allow them to contribute substantially to their organizations. University-based colleges and schools of pharmacy may offer training through their continuing education departments, but unless training is provided through degree-granting programs, their involvement will be limited. Dr. Swarthout has declared no potential conflicts of interest. Rena M. Conti, Ph.D., Associate Professor, Department of Markets, Public Policy and Law, Questrom School of Business, Boston University, Boston, MA. Strategic Information System Planning (SISP) is instrumental in making informed decisions to achieve the health organizations' goals and objectives. Healthcare Executive, Ridgewood, NJ. Today, health care providers require more patient-centric, value-based approaches, whereas many of their current systems follow older, more traditional strategy … Medicare for All? Older models for strategic planning consists of a variety of … 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. Pharmacy departments should take advantage of institutional resources aimed at managing that risk but should also focus on prevention of events that are unique to their physical space and their staff workflows. Taleb’s exposition1 includes rules for mitigating negative black swans and exploiting those that are positive. (Observer). 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 … This article presents the principles of strategic planning and outlines processes that your practice can adapt for short- or long-term planning. All of these drivers of change point to a shift in the delivery system toward clinically appropriate care in the community, with the home as a central node.1 As illustrated in Figure 3, technology and policy will need to shift to accommodate these changes and deliver appropriate care to patients.1 Consistent with this paradigm shift, payers and providers engaged in APMs are developing a key strategic emphasis on shifting the site of care toward the community and the home. Another possible solution discussed at various stakeholder meetings is the establishment of an essential drug list (such as the list maintained by the World Health Organization7), with targeted incentives to ensure availability of key products. Heymach J, Krilov L, Alberg A et al. 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. Should state laws and regulations mandate accredited training for technicians, many institutions will collaborate with community colleges to meet their training needs. The challenges faced by health-system SPs will continue to include access to payer networks, access to limited-distribution drugs, and (with the exception of health systems with access to 340B pricing) profitability. Contact Us Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. Rather, the report is, at its core, a provocative stimulant for the thinking, discussion, and planning that must take place in every hospital and health system in order for those organizations to succeed in their mission of caring for patients and advancing the profession of pharmacy. 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. 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. G. Caleb Alexander, M.D., M.S., Professor of Epidemiology and Medicine, Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD. Lee C Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, Meghan D Swarthout, Pharm.D., M.B.A, G Caleb Alexander, M.D., M.S, Diane B Ginsburg, B.S.Pharm., M.S., Ph.D., FASHP, Katie O Pritchett, Ph.D., Lecturer, Sara J White, M.S., FASHP, Jennifer Tryon, Pharm.D., M.S., FASHP, Conrad Emmerich, M.B.A, Todd W Nesbit, Pharm.D., M.B.A., FASHP, William Greene, B.S.Pharm., Pharm.D., BCPS, FASHP, FCCP, Erin R Fox, Pharm.D., BCPS, FASHP, Rena M Conti, Ph.D, Bruce E Scott, B.S.Pharm., M.S., FASHP, Frank Sheehy, B.A., M.B.A, Michael J Melby, B.S.Pharm., M.S, Mark A Lantzy, James M Hoffman, Pharm.D., M.S., BCPS, FASHP, Scott Knoer, M.S., Pharm.D., FASHP, William A Zellmer, B.S.Pharm., M.P.H, ASHP Foundation Pharmacy Forecast 2020: Strategic Planning Advice for Pharmacy Departments in Hospitals and Health Systems, American Journal of Health-System Pharmacy, Volume 77, Issue 2, 15 January 2020, Pages 84–112, https://doi.org/10.1093/ajhp/zxz283. 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. 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. 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. (Pharmaceutical Supply Chain). That is not only acceptable, it is desirable. Data from the University of Utah Drug Information Service show a 57% increase in ongoing and active drug shortages, from 176 in 2017 to 276 in 2019. Adding to a pharmacy leader’s portfolio of responsibility creates opportunities for sharing experience and resources across multiple departments. Direct pharmacist involvement is critical to ensure that patients benefit from a medication-use system designed to ensure that appropriate efficacy, safety, and cost considerations are addressed. A majority of FPs indicated they believe this is a likely occurrence in many departments (Figure 3, item 3). The value of the report, however, is defined by its use by health-system pharmacists and health-system pharmacy leaders as they use the report to inform their strategic planning efforts. 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. Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. Incentives may also result in unintended consequences such as drug manufacturers focusing efforts on a few products and discontinuing other products that may also be clinically relevant but not deemed “essential.” There is little evidence that such incentives would alleviate shortages, at least in the short term. ASCO Connection 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. 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 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. 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). 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. 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. Cancer.Net, ASCO.org Two survey items addressed these concerns. 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. Scott Knoer, M.S., Pharm.D., FASHP, Chief Pharmacy Officer, Cleveland Clinic, Cleveland, OH. The mixed survey response is likely a reflection of the complexity that would be involved in establishing such a recognition program. 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. This article describes the strategic management system used at TEGH and demonstrates the formal integration of the plan into its operating and decision making processes. For example, Kentucky recently joined California and a few other states in expanding the pharmacist scope of practice, granting independent prescribing authority (to be exercised in collaboration with physicians) under approved protocols for a wide range of conditions, including acute infections, tobacco cessation, and opioid use disorder.1. However, 4 organizations (CVS Health, Cigna/ESI, Walgreens, and UnitedHealth Group) represent 70% of specialty drug revenues.5 Market domination by SPs aligned with insurers will likely continue, as will shared contracting with clients, restricted access to limited distribution medications, and closed SP payer networks. 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. This edition of the report differs from the first 7 editions, just as each previous version differed from earlier versions. This process is particularly valuable when addressing phenomena that are not well suited to quantitative predictive methods. 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). 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. The 2020 Pharmacy Forecast is intended to assist with strategic planning efforts by health-system leaders. They argue that involvement of suppliers, customers, shareholders and employees in strategic change easens the strategy implementation by reducing the level of resistance and opposition to strategic implementation process. 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. Invest in the collection of PRO data using validated questionnaires, and make the information readily retrievable in the EHR for frontline staff. ASCO Author Services 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). 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. Strategic planning in health care has undergone a shift over the past 50 years. Such government actions may include eliminating patent manipulations that prolong the time it takes for generic drugs to be introduced into the market, prohibiting financial deals among companies that prevent the timely introduction of generic drugs, and resolution of alleged price fixing among generic drug companies. However, skills provided in joint Pharm.D./M.B.A. Strategic Planning in Healthcare: An Introduction for Health Professionals is a practical guide to the theory of strategic planning and the principles of strategic management that apply to all organizational settings, including large healthcare networks, small practices, and public health institutions, among many others. 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. Advertisers, Journal of Clinical Oncology Strategic planning, disciplined effort to produce decisions and actions that shape and guide an organization’s purpose and activities, particularly with regard to the future. (Healthcare Marketplace). Address correspondence to Mr. Zellmer (firstname.lastname@example.org). Journal for Nurses in Professional Development: 11/12 2017 - Volume 33 - Issue 6 - p 318-319 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. We are again pleased to disseminate the Pharmacy Forecast through AJHP, providing readers with easy access to the report. Address correspondence to Dr. Nesbit (email@example.com). Both examples represent troubling milestones in resetting the definition of “expensive drug.”. 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. 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. 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. Sara J. 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. The Moore County Hospital has been debating whether to establish its governing policies based on input from one focus group of former patients and another focus group of clinicians. strategic planning process and communicate the outcomes in a way that inspires, invests, and ultimately drives change for these individuals. Published online 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. 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?”. 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. However, they quickly learned that 80 pharmaceutical manufacturing facilities were concentrated in Puerto Rico. 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. Finally, as pharmacists are increasingly relied upon to provide system-wide leadership, the Pharmacy Forecast addresses many issues that are relevant well beyond the traditional boundaries of pharmacy and the medication-use process. 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). Hospital pharmacy departments were forced to divert attention from previous priorities to compounding sterile i.v. The authors have declared no potential conflicts of interest. Health-system pharmacists must continue to plan for manufacturing quality deficits resulting in recalls and shortages, as well as higher drug prices. products, necessitating a specially trained and certified pharmacy workforce. Pharmacy departments have significant costs but limited ability to create billable revenue under the traditional fee-for-service structure. Oxford University Press is a department of the University of Oxford. bBased on 2018 U.S. Census population data (estimated). 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