Welcome to AJHP’s interactive tool for the 2017 ASHP Foundation Pharmacy Forecast Report1. This tool allows you to respond to the same Pharmacy Forecast survey questions posed to the Forecast Panelists and compare your answers to the panelists’ responses. Survey questions are available for the following domains:
At least 75% of health systems will have formal, assertive programs aimed at achieving the highest quality at the lowest cost for specific patient populations (e.g., oncology, diabetes, inflammatory and immune disorders) across the continuum of care.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 50% of health systems will significantly expand their nonmedical support services (e.g., transportation, health education, counseling, patient engagement) to address factors related to poor health.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 25% of health systems will be heavily engaged with community leaders in programs to manage the non-medical/social determinants of health (e.g., environmental, cultural, and economic factors).
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 50% of health systems will serve high-risk patients (e.g., those with cancer, congestive heart failure, HIV) through formal programs with community pharmacies (e.g., for adherence coaching, patient monitoring) that they own or are in partnership with.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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Through the integration of behavioral health services with primary care, at least 25% of health systems will achieve significantly better outcomes related to comorbid conditions in patients who suffer from mental health disorders.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 75% of health systems will have a major campaign aimed at improving the prescribing of opioids.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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1. Leverage the pharmacy enterprise to achieve optimal medication adherence by high-risk patients. In pursuit of this goal, include risk-stratification techniques, telehealth applications, collaborative practice in clinics and community pharmacies, refill authorization, compliance packaging, and bedside discharge-prescription delivery.
2. If your institution self-insures its employees for healthcare coverage, use that program to pilot innovative pharmacy services (such as targeted disease state management) that can be offered to other health-benefit plans.
3. Create a pharmacy refill clinic that allows physicians to optimize their time with patients while improving medicationuse safety, adherence, and outcomes.
4. Identify and implement ways for the pharmacy enterprise to actively contribute to your health system’s support services for high-risk patients, including efforts in telehealth, patient education, and motivational interviewing for improving adherence.
5. Assertively incorporate a behavioral health component into pharmacist patient care, including chronic disease management and prescription assistance programs.
6. Ensure that your pharmacy enterprise is actively addressing the opioid crisis through means such as an opioid stewardship program, effective opioid-diversion prevention, support of prescription-medication disposal programs, and promotion of improved public access to naloxone.
At least 25% of health systems will have formal innovation centers designed to pursue breakthroughs in areas such as patient experience, clinical outcomes, operational efficiency, technology, and revenue from entrepreneurial ventures and intellectual property.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 50% of health systems will repurpose one or more acute-care facilities to post-acute-care facilities.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 75% of health systems will expand and accelerate their analysis of how alternative interventions affect both cost per episode and quality of care.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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In at least 25% of health systems, most high-cost chronic-care patients will receive some of their ongoing care through telehealth applications.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 50% of health systems will implement assertive behavior-modification programs for improving the prescribing of antimicrobials, for both inpatients and outpatients.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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The pharmacy enterprise in at least 50% of health systems will, through data analytics, measure its contribution to patient care outcomes.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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1. Investigate the nature of the innovation center at your health system or at other health systems in your region. Establish a relationship with the leaders of such centers and explore potential win-win collaborations related to opportunities or imperatives in the pharmacy enterprise.
2. Reach out to executive and clinical leaders at your health system and offer a pharmacy enterprise perspective on contingency planning for declining inpatient admissions. Give special attention to challenges and opportunities related to observation units and post–acute care facilities.
3. Assertively work toward transitioning from process-based quality measures to outcome measures. Structure outcome measures in a way that allows quantification of the impact of the pharmacy enterprise on patient care. Prepare pharmacists for the critical thinking skills needed to participate in real-time data-driven patient care changes.
4. Become engaged with your health system’s strategy on telehealth, particularly related to medication management issues including adherence. Develop competence in mobile device apps related to medication management and patient adherence.
5. Assertively pursue, through the pharmacy and therapeutics committee, the application of behavioral modification techniques as a means of improving antimicrobial use.
At least 50% of health systems will have significantly reorganized their information technology infrastructure (including electronic health records) to achieve true system-wide integration.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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In at least 50% of hospitals, interoperability between electronic health records and medical devices (e.g., infusion pumps, physiologic-monitoring systems) will lead to measurable improvements in patient outcomes and staff productivity.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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In at least 25% of health systems, health data generated by ambulatory patients (such as from wearable devices) will be integrated into the patient’s electronic health record in real time.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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Patients in at least 25% of health systems will have a single plan-of-care that is readily accessible at all points of care and can be updated by all healthcare professionals in the system and by the patient.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 10% of health systems will be the victim of a major cyberattack or unauthorized information-system access that seriously compromises patient safety.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 50% of healthcare consumers will use an on-line provider report card to help decide where to seek medical care.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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1. Assertively pursue system wide integration of medication-related information technology using sound project management techniques (e.g., clear goals, accountability, deadlines). Establish system wide standards for safety-related facets of medication use (e.g., i.v. drug concentrations) and workflow.
2. Through the pharmacy and therapeutics committee, establish policies that clearly assign responsibilities for i.v. pump configuration, user training, support, and maintenance. Ensure that the formulary and all medication-use processes are consistent with the i.v. pump configuration.
3. Ensure that pharmacy has a voice in your health system’s preacquisition assessment of devices that would affect medication use and monitoring. In those assessments, take into account human factors and interoperability with electronic health records.
4. If your health system has centralized patient care plans, ensure clarity in the process for pharmacists accessing and entering information into those plans.
5. Give priority to reviewing the access security of all pharmacy-managed technology systems. Test downtime workflow processes and procedures for each system, and make improvements as indicated.
6. Identify the pharmacy-specific metrics displayed (or likely to be displayed) on your health system’s provider report card and develop a continuous quality-improvement plan for those measures.
For at least 10% of patients, clinicians will use a combination of genomic information, lifestyle/environmental history, and information collected from medical devices (e.g., wearable or mobile applications) to individualize treatment plans.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 25% of specialty medications will be approved for marketing based on limited evidence (e.g., clinical trials with small sample sizes, narrowly defined target populations, preliminary clinical findings).
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 75% of health systems will develop disease-specific treatment algorithms to manage the use of specialty medications across the patient’s continuum of care.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 25% of health systems will have a formal agreement with a payer designed to enhance cost-effective use of specialty medications.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 10% of new medications used in health systems will have unique requirements for storage, preparation, administration, or monitoring that necessitate distinct workflow processes.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least three new antimicrobial agents will be approved by the FDA to treat infections that are resistant to currently available therapies.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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1. Actively evaluate your health system’s opportunities to incorporate precision medicine approaches in patient care, with the aim of improving therapeutic selection, dosing, and patient outcomes.
2. Actively guide the pharmacy and therapeutics committee’s assessment of new products that were approved for marketing with limited clinical evidence. Assertively advocate a rational therapy perspective in cost management discussions about such products with third-party payers and health plans.
3. Actively support your health system’s executives in (a) assessing the risks and benefits of including medications in episode-of-care payment agreements and (b) negotiating alignment of health-system goals and payer goals in managing the cost of new medications.
4. Create an interprofessional task force to inventory the health system’s existing third-party payer treatment pathways for the purposes of (a) comparing the pathways to current evidence-based practices, (b) monitoring pathway adherence, (c) evaluating patient outcomes, and (d) when indicated, pursuing modifications to pathways.
5. Critically evaluate the site of care for high-cost medication administration, and transition patients to alternative sites of care when appropriate.
6. Strengthen health-system processes for reviewing antimicrobial resistance, utilization trends, and (when indicated) prescribing remediation, recognizing that near-term development of new antimicrobials might not solve the problem of resistance to existing agents.
At least 50% of health systems will apply the concept of “incremental value” in formulary decisions and clinical guidelines through assessment of pharmacoeconomic data (i.e., cost per quality-adjusted life years and incremental cost-effectiveness ratios).
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 25% of health systems will have risk-sharing agreements with biopharmaceutical manufacturers that call for price discounts if a product’s performance fails to meet specified targets.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least two major pharmacy benefit management companies will reimburse expensive new medications only up to the limit of their own (not the manufacturer’s) value-based pricing calculations.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 25% of health systems will be able to document that their formal programs for managing patients receiving specialty medications significantly improve patients’ disease-related outcomes.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 50% of health systems will require clinicians to first try low-cost treatments (when such treatments exist) before allowing the use of a new high-cost therapy.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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In at least 50% of health systems, oncology treatment decisions will take into account the patient’s financial obligations for the treatment regimen.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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1. Assertively integrate value into your health system’s formulary decision-making process by including metrics such as number needed to treat to achieve outcomes, cost per quality adjusted life-year, cost per year of life gained, and incremental cost-effectiveness ratio.
2. Actively manage specialty medication use in your health system by (a) developing therapeutic algorithms and outcome metrics for patients receiving specialty medications (while advocating for a healthcare data infrastructure that facilitates this approach) and (b) designing risk-sharing contracts for specialty medications based on
achievement of specific, measurable clinical outcomes.3. Lead your health system in developing a process for engaging patients in treatment decisions by providing them with information about cost (including out-of-pocket cost) and outcomes (e.g., cost per year of life gained, progression free survival time) of available options.
4. Lead pharmacy and therapeu tics committee review of your health system’s policy on the use of manufacturers’ prescription-drug coupons, given that such programs increase overall medication costs.
At least 25% of health systems will have a centralized multidisciplinary compliance staff to ensure consistent regulatory compliance throughout the system.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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The amount of time that health-system pharmacy personnel devote to regulatory compliance will increase by at least 25.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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In at least 25% of health systems, a pharmacist who specializes in sterile compounding will oversee the quality and safety of this activity throughout the health system.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 25% of health systems will have at least one pharmacist position devoted to appropriate control and use of pain medications, especially opioids.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 75% of health systems will have at least one pharmacist position devoted to antimicrobial stewardship for both inpatients and outpatients.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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State boards of pharmacy will assertively move toward a high level of nationwide uniformity in the regulation of health-system pharmacy practice, including the training and duties of pharmacy technicians.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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1. Assertively articulate the pharmacy regulatory requirements that must be accommodated in your health system’s comprehensive compliance infrastructure. Establish clear lines of communication and accountability in your health system for compliance with new pharmacy-related regulatory requirements.
2. Invest in the necessary resources (including staff) to meet stricter requirements for sterile compounding. Pursue a uniform systemwide approach toward sterile-product quality. If you pursue outsourcing of sterile compounding, consider ASHP guidelines in the selection of a registered 503B compounder. If you use an outsourcing service, prepare a contingency plan for responding to recalls or facility closure.
3. Develop or recruit pharmacists with expertise in pain management and infectious diseases to meet regulatory demands in inpatient and ambulatory care. Work through the pharmacy and therapeutics committee to ensure stewardship awareness and competence of all health professionals with respect to the use of opioids and antimicrobials. Select pharmacy technicians for specialized training and roles in the logistical management of controlled substances.
4. Develop real-time reporting/alerting tools to monitor and support regulatory compliance and stewardship. Such tools might relate to isolates of infectious organisms, opioid prescribing patterns, signals of potential diversion, and assessment of sterile compounding needs.
5. Pursue assertive advocacy on pharmacy-related regulatory issues at both the state and national levels. Analyze proposed standards or regulations and submit comments as indicated; encourage state and national pharmacy associations to support your position. When indicated, request health system executives, members of the board of trustees, and state hospital associations to add their voice in support of your advocacy.
Some pharmacists in at least 75% of health systems will have prescribing authority (formally approved by the system) for both inpatients and discharged patients.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 10% of health systems will hire a non-pharmacist professional manager to assist the chief pharmacist in high-stakes management functions.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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Overall enrollment in PharmD education will decline by at least 10.
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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At least 50% of health systems will have a formal plan for achieving an appropriate balance between (a) applying valid teaching methods in Advanced Pharmacy Practice Experience (APPE) education and (b) the productivity of PharmD students on APPE rotations.
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At least 50% of health systems will have formal career ladders for pharmacy technicians.
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In at least 50% of health systems, specialized pharmacy technicians will assist pharmacists in providing patient care (e.g., by conducting medication reconciliation, taking medication histories, extracting data from health records).
How likely is it that this will occur by the year 2021 in the geographic region where you work?
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1. Identify the specific clinical knowledge, skills, and abilities that will be required of your pharmacist staff within the next several years (taking into account trends in therapeutics and healthcare delivery and financing). Formulate a staff development and recruitment plan to meet those needs.
2. Objectively assess the evolving requirements for management skills in your pharmacy enterprise and impartially evaluate to what extent, if any, those requirements could be met by nonpharmacist managers. Adjust your staff development and recruitment plans accordingly.
3. Give strategic priority to professionalizing the pharmacy technician staff, identifying and acting on opportunities for job enrichment, career advancement, salary alignment with expanded responsibility, and fostering career longevity.
4. Actively pursue opportunities to support expanded accredited pharmacy technician education and training in your region.
The new president will propose to Congress an extensive revision or replacement of the Patient Protection and Affordable Care Act.
How likely is it that this will occur if the Republican candidate is elected?
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The new president will actively support federal provider status for pharmacists.
How likely is it that this will occur if the Republican candidate is elected?
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The new president will seek congressional authority to negotiate drug prices for federal health programs (e.g., Medicare, Medicaid).
How likely is it that this will occur if the Republican candidate is elected?
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The new president will seek congressional approval of a federal mechanism to influence the pricing of new pharmaceuticals, drawing on the experience of countries such as the United Kingdom, Canada, and Australia.
How likely is it that this will occur if the Republican candidate is elected?
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The new president will propose legislation that allows the importation of quality-assured pharmaceuticals as a means of increasing price competition.
How likely is it that this will occur if the Republican candidate is elected?
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The new president will direct the Drug Enforcement Administration to reclassify marijuana from Schedule I to Schedule II under the Controlled Substances Act.
How likely is it that this will occur if the Republican candidate is elected?
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1. Assume that healthcare reform will be an ongoing priority and that health systems will continually pursue improved patient outcomes and reduced costs. Ensure that your pharmacy staff has empowered, ready-for-action expertise that leads, stimulates, and motivates improvements in all dimensions of the pharmacy enterprise.
2. In coordination with your health system’s public policy advocates, encourage one or more practitioners in your pharmacy enterprise to cultivate first-name relationships with your elected representatives at the state and federal levels. Ensure that those representatives have a basic understanding of the thrust and value of contemporary pharmacy practice.
3. When you experience pharmaceutical pricing that clearly exceeds the bounds of fairness and value, inform your state and federal elected representatives and the local media of the situation.
4. Cooperate with progressive community pharmacy practice leaders in your region in developing a communications plan, focused on elected representatives and the media, that showcases a variety of pharmacist practices that have positive effects on the quality and cost of patient care.
Read the entire 2017 ASHP Foundation Pharmacy Forecast Report1 to learn more about the panel’s responses to the survey questions and strategic planning recommendations for pharmacy departments.
1. Zellmer WA, ed. Pharmacy forecast 2017: strategic planning advice for pharmacy departments in hospitals and health systems. Am J Health-Syst Pharm. 2016; 73:e617-43.