Pharmacy Executive Research Articles

ASHP Pharmacy Executive Leadership Alliance (PELA®) Symposium: Service Line Business Development and Payer Engagement.

ASHP Pharmacy Executive Leadership Alliance (PELA®) Symposium: Service Line Business Development and Payer Engagement.

Pharmacy leaders find common ground on population health.

Participants in ASHP’s August 24 Pharmacy Executive Leadership Alliance (PELA®) and the Section of Pharmacy Practice Leaders forum say that the profession’s path forward on population health management runs through strategic initiatives focusing on quality metrics for public and private payers. What’s still unclear is exactly where to direct the profession’s efforts to meet payers’ quality expectations. “Do we prioritize putting pharmacists in internal medicine practices versus family medicine, [because] internal medicine patients tend to be more complicated?” asked presenter Fern Paul-Aviles, assistant vice president for population health strategy, 340B, community clinic pharmacy services, behavioral health, and long-term care for Charlotte, NC–based Atrium Health. “Do you put more pharmacist resources in the practices that have more value-based contracts? Or do you look at where the worst quality scores are and allocate pharmacists where the worst quality scores are in the hope of improving the quality scores in those practices?” Fern-Aviles said her health system has shared-savings contracts with 4 Medicare Advantage plans. To secure the full financial incentives and attain the highest Medicare star rating, the healthcare team must meet medication adherence targets for beneficiaries taking statins, antihypertensive drugs, and diabetes medications.

Assessment of burnout and pandemic fatigue among pharmacy leadership in the Veterans Health Administration healthcare system.

PurposeFactors associated with burnout in Veterans Health Administration (VHA) pharmacy leadership positions were examined during the coronavirus disease 2019 (COVID-19) pandemic.MethodsA questionnaire was distributed to all pharmacy executives of the VHA healthcare system. It collected demographic and employment characteristics, career satisfaction and work-related variables, indicators of burnout using validated single-item measures adapted from the Maslach Burnout Inventory, and the impact of the COVID-19 pandemic on psychosocial and work-related variables. A χ 2 test with Bonferroni correction was used to evaluate the data. Burnout was defined as a score of 4 or greater on either of the 2 single-item validated statements adapted from the Maslach Burnout Inventory to assess emotional exhaustion and depersonalization.ResultsIn total, 407 (of 1,027; 39.6%) VHA pharmacy leaders representing Veterans Integrated Service Network pharmacy executives, chiefs of pharmacy, associate chiefs of pharmacy, and inpatient and outpatient supervisors completed the survey. The overall prevalence of burnout was 68.6% using the aggregate measure of emotional exhaustion or depersonalization. Pharmacy leaders who worked more than 60 hours a week reported significantly greater rates of burnout than those who worked 40 to 60 hours a week (86.7% vs 66.9%, χ2 = 7.34, degrees of freedom = 1, P < 0.05). Those experiencing increased workload related to COVID-19 also reported high burnout rates (72.1%, χ2 = 16.40, degrees of freedom = 1, P < 0.001). Burnout scores were similar across groups when respondents were stratified by leadership position, gender, age, or years in position.ConclusionAs of March 2021, two-thirds of pharmacy leaders were experiencing burnout. It is important for healthcare system leadership to identify patterns of burnout among their pharmacy leaders to ensure a productive and sustainable workforce.

Pharmacy services across the continuum: Leveraging opportunities and organisational strategies to improve market competitiveness

Medication utilisation is one of the ubiquitous modalities of medical interventions in our healthcare system and an area of high complexity and high cost for many patient populations. Assessment of the use of medications both in acute and ambulatory care settings has become increasingly important for hospitals and health systems as organisations become larger and more integrated and must manage the payer and external provider changes in the marketplace. The COVID-19 pandemic emphasised the critical nature of the drug supply chain for essential medications and the strategic imperative for health systems to have an enterprise-wide medication use strategy. This strategy must ensure evidence-based use of medications to improve patient safety, outcomes, effective cost management, as well as secure and expand revenue-generating patient care services to support the overall health and sustainability of the organisation. Essential to accomplishing these goals is having a pharmacy executive as part of the health systems’ enterprise strategic planning to ensure that patients’ clinical needs, organisational revenue cycle, and new ventures are integrated across the continuum to optimise patient outcomes and patient retention.

Clinical pharmacists as pharmacy executives: Yes!

Clinical pharmacists as pharmacy executives: Yes!

A Study Protocol to Assess the Pharmacy Revenue Leakage in AVBR Hospital, Sawangi (M), Wardha

AVBR hospital is the largest hospital in private sector in central India, having bed strength of 1,500. It has 2,000 or more patients on an every day basis, and around 1,500-1,200 prescription generated. This study mainly conducted to improvise the pharmacy revenue, patient satisfaction, and avoid revenue leakage in AVBRH amongst private sector hospital. The pharmaceutical enterprise's ability efficiently manage the revenue cycle has become a major strategic concern for hospitals and health systems. The organization's short- and long-term financial viability may be jeopardized if the subtleties of this complex process were overlooked. Pharmacy executives are responsible for delivering excellent financial outcomes, while also improving the patient experience. Financial success in today's healthcare businesses demands more than cost-cutting and defensive methods. To ensure revenue integrity, on both the front and back ends of the hospital revenue cycle, the focus should be on root-cause analysis and process optimization. Hospitals are increasingly forming revenue integrity teams in order to obtain a better understanding of their business operations and help provide the processes, communication, accountability, and leadership required for optimum reimbursement and compliance.

Health-system pharmacy executives discuss hospital-at-home model at ASHP's third PELA event.

ASHP’s Pharmacy Executive Leadership Alliance (PELA) convened November 4, 2021, for the group’s third virtual event, Hospital at Home and Alternate Sites of Care: Leading Pharmacy Services in a Shifting Landscape. The meeting brought together pharmacy executives and experts from across the country to strategize on how pharmacy can best contribute to the expansion of acute-level care beyond hospital walls. The event extended discussions of the topic that took place during ASHP’s 2021 Policy Week activities in September. ASHP Chief Executive Officer Paul W. Abramowitz, in his opening remarks, emphasized ASHP’s commitment to supporting the full integration of pharmacy services in hospital-at-home care models. “We’re looking ahead at ways to help create the future and lead through these innovative models to ensure that optimal medication therapy outcomes are achieved,” Abramowitz said. “ASHP’s member groups, government relations, and policy development processes are all aligning to support the necessary infrastructure needed to...

ASHP Statement on the Roles and Responsibilities of the Pharmacy Executive.

Leading hospitals and health systems must have a strategic and innovative pharmacy executive who plans and oversees the design and operation of the entire and complex medication-use process throughout the system. It is essential that this leader report to an executive who can help the leader execute the practice models of tomorrow that include business outside normal hospital practice. As the most knowledgeable leader of the medication-use process, this leader (may be referred to as the “chief pharmacy officer” but hereafter “the pharmacy executive”) proactively aligns pharmacy goals with strategic organizational initiatives to advocate for pharmacy practice advancement and improved patient care. The intrinsic value a pharmacy executive brings to the organization’s enterprise and executive leadership includes the following: ... Significant changes in pharmacy practice, healthcare, and health-system management over the past 20 years have dramatically transformed the traditional role of the pharmacy director.1 More widespread use of the title “chief pharmacy officer” was first proposed in 2000 in an attempt to meet these new transformations and to enhance the contribution pharmacy makes to patient care by creating organizational parity between the pharmacy executive and other executive officers (e.g., chief nursing, medical, and information officers).2

Implementation of Pharmacy Executive Quality and Safety Walkrounds at a Tertiary Academic Medical Center.

Background: Executive Quality and Safety WalkRounds (EWRs) is a tool that engages department leadership in discussion with the front-line employees to solicit feedback to improve quality and safety. The purpose of this study was to evaluate the impact of the implementation of pharmacy department specific EWRs on quality and safety at a tertiary academic medical center. Method: This was a single-center, retrospective analysis conducted at Brigham and Women's Hospital between November 2016 and November 2019. This study aimed to analyze the implementation of EWRs conducted every other month throughout various service areas and satellites of the pharmacy department. Data evaluated included the number of EWRs conducted, the specific areas visited, the total number of action items recommended by the staff, along with the total number of action items that were completed or remained in process. Results: During the study period, 17 visits were completed in 12 different BWH pharmacy sub-departments. A total of 98 operational, technological, and environmental action items were recommended by staff to improve quality and safety. Of the 98 action items documented, 95 (96.9%) were completed by time of our analysis. Conclusion: Pharmacy department EWRs are an important and systematic process of communication between the pharmacy leadership and frontline staff. Pharmacy department EWRs have resulted in safety and quality improvements at different levels in the pharmacy department. The EWRs program at the pharmacy department was effective in identifying and completing safety initiatives to improve the safety culture of the department.

ASHP Pharmacy Executive Leadership Alliance kicks off with discussion with AHA CEO Richard Pollack.

ASHP’s Pharmacy Executive Leadership Alliance (PELA™) held its inaugural event virtually Oct. 29 to celebrate the creation of the new ASHP member engagement opportunity, share experiences, and brainstorm about innovations that will drive financial and organizational recovery from the effects of the COVID-19 pandemic. PELA™ was created by ASHP for chief pharmacy officers and multihospital system pharmacy executive leaders who face distinct challenges working within highly complex vertically and horizontally integrated networks and multihospital health systems. The inaugural session of what is just the start of a series of events included more than 160 pharmacy executives representing chief pharmacy officers and directors of pharmacy from more than 100 multihospital health systems and 80 major hospitals and academic medical centers. “The idea for PELA™ has been at the forefront of ASHP leadership discussions for some time,” said ASHP Chief Executive Officer (CEO) Paul W. Abramowitz. “We understand that there is a...

A comprehensive approach to addressing the opioid epidemic in a large health system.

To describe the implementation of a comprehensive program to address the opioid epidemic in a large health system and to assess the effect of the program on opioid prescribing. Mercy Health is a nonprofit, Catholic health system that employs over 1,400 providers and operates 23 hospitals in Ohio and Kentucky, 2 states that have experienced large numbers of overdoses. As a good community partner, the health system developed a comprehensive plan to address the opioid crisis. A system-wide Opioid Steering Committee was established to implement and manage the program. The committee was chaired by a senior pharmacy executive and supported by 4 subcommittees: the data analytics, education development, outreach and assessment, and electronic health record (EHR) subcommittees. The 4 subcommittees developed and implemented several initiatives, including forming a database with prescribing data by specialty and geographical location, implementing a standardized screening approach in the emergency department, challenging hospitals to create partnerships with local schools, and creating EHR enhancements to change opioid prescribing habits. When normalized for patient volume, the prescribed opioid burden was reduced from 65.3 to 35.2 morphine milligram equivalents per unique patient from 2016 to 2019 (a 46% absolute reduction). During this same time the number of acute prescription orders with a morphine equivalent dose greater than 30 was reduced by 52% (from 37,793 to 17,822 prescriptions per year). Mercy Health's comprehensive approach to the opioid epidemic has successfully impacted opioid prescribing habits, screening practices, and community outreach.

It's time for a "beyond-use date" for designating health-system pharmacy as a center of excellence.

In the article, the authors discuss the need to designate health-system pharmacy as center of excellence Other topics include the need to create a high-value pharmacy enterprise (HVPE) framework as proposed by the Vizient Pharmacy Executive Committee in 2018, and the challenges facing healthcare systems amidst the COVID-19 pandemic in areas like cost of care, patient access, and financial performance

Community Pharmacy Engagement in Diabetes Prevention: Key Informant Interviews with Pharmacy Executives.

IntroductionEven though evidence-based diabetes prevention interventions exist, more than 1 in 3 Americans have prediabetes; the use of pharmacies has been explored as a way to reach and care for this population. The objective of this study was to analyze factors that influence adoption of type 2 diabetes prevention programs by community pharmacies.MethodsWe conducted 21 semistructured interviews in 2018 with decision makers from 11 independent pharmacies in 6 US states and the District of Columbia and from 10 chain pharmacies operating in 1 state, multiple states, and nationwide. We identified participants by using purposive sampling. We used qualitative methods to analyze data and conducted interviews until we reached saturation.ResultsMultiple themes emerged: 1) initiation of services is more likely if initial financial support is received; 2) patient demand for services, actual or perceived, is paramount; 3) diabetes prevention services often fit within the existing operations of a pharmacy and allow maximum use of resources; 4) customer loyalty is a clearly articulated advantage against competition; and 5) engagement in diabetes prevention affirms an expanded role and the value of pharmacies to serve communities.ConclusionPharmacies are well situated to deliver diabetes prevention programs to communities. Although considerable opportunity exists for pharmacies to address diabetes prevention, more could be done to reduce barriers to their use.

Current Trends in Hospital Pharmacy Practice in Lebanon.

Objectives: For decades, the role of hospital pharmacists has been instrumental in elevating pharmacy practice worldwide. Recently, the Hospital Pharmacy Section of the International Pharmaceutical Federation (FIP), the European Association of Hospital Pharmacists (EAHP), and the American Society of Health-System Pharmacists (ASHP) updated their statements about the future role and responsibilities of the pharmacy executive in hospitals and health systems. A series of surveys were conducted around the globe to better understand the current state of hospital pharmacy practice. The purpose of these surveys was to identify challenges in hospital pharmacy practice and to develop improvement strategies. The objective of this national survey is to evaluate hospital pharmacy practice in Lebanon. Methods: A cross-sectional observational study was performed among pharmacists working in hospital settings in Lebanon, from January through June 2016. Based on a literature review, a questionnaire to elicit Lebanese hospital pharmacists' practice was developed. Results: The results showed a nonsignificant difference between university teaching and nonuniversity teaching hospitals in the processes of drug procurement, preparation, dispensing, and drug administration. However, statistically significant differences were observed between university teaching and nonuniversity teaching hospitals with respect to having clinical pharmacists (P < .001) and highly qualified personnel (P < .005). Pharmacy services in teaching hospitals seemed to be more advanced cooperating with affiliated medical schools. Furthermore, teaching hospitals were more likely to have pharmacists providing information about the safety of the medications used (P = .029). Although not statistically significant, there was a higher trend toward having a designated champion for medication safety (P = .052). Conclusion: The results of our survey showed that teaching hospitals were more compliant with the International Statements of Hospital Pharmacy Practice compared with nonteaching hospitals. There is room for improvement especially if the application of the accreditation standards for safe hospital pharmacy practice becomes mandatory for all hospitals, which is expected to standardize pharmacy practice and secure both medication and patient safety.

PHP130 - Growth of Hospital-Owned Specialty Pharmacies: Importance and Implications for Manufacturer Channel and Patient Access Strategies

There has been a recent proliferation of hospital-owned specialty pharmacies. In 2016, Navigant surveyed 64 executives representing large health and hospital systems and found that one-third of organizations have specialty pharmacy capabilities and a further 45% are considering adding them in the future. This research explores dynamics impacting this channel, as well as its importance for manufacturer distribution and patient access strategies. Primary research was conducted with N=8 pharmacy executives representing large provider systems with specialty pharmacy capabilities, as well as payers familiar with contracting for these entities. Issues including performance and outlook, key business challenges, and relations with manufacturers and payers were discussed. Supplemental secondary analysis was also conducted, including review of pharmacy networks for recently launched specialty drugs. Key challenges for hospital-owned specialty pharmacies include access to limited drug distribution networks and payer networks. However, several market forces are working in favor of this channel: hospital consolidation and changing physician employment models; risk-based contracting requiring integrated pharmacy management; and adoption of enterprise pharmacy strategies which increase system control over prescribing. Furthermore, hospital-owned specialty pharmacies are expanding wrap-around services to demonstrate unique value to patients, payers and employers. 340b pricing has helped eligible institutions compete for payer network access, although this “crutch” may be at risk in light of recent program changes. Hospital-owned specialty pharmacies are increasing in number, and there are several reasons to believe the channel is of growing strategic importance to manufacturers. These entities have potential to improve the patient experience, coordination of care, and outcomes, and are more closely aligned with prescribers in the affiliated system. Still, the tradeoffs surrounding a move towards larger, more inclusive specialty pharmacy networks needs to be carefully considered, as key benefits of limited distribution including consolidation and control may be foregone.

Designing organizational structures: Key thoughts for development.

Current strategies and concepts to consider in developing a system-level organizational structure for the pharmacy enterprise are discussed. There are many different ways to design an organizational structure for the pharmacy enterprise within a health system. The size of the organization, the number of states in which it operates, and the geographic spread and complexity of the pharmacy business lines should be among the key considerations in determining the optimal organizational and decision-making structures for the pharmacy enterprise. The structure needs to support incorporation of the pharmacy leadership (both system-level executives and local leaders) into all strategic planning and discussions at the hospital and health-system levels so that they can directly represent the pharmacy enterprise instead of relying on others to develop strategy on their behalf. It is important that leaders of all aspects of the pharmacy enterprise report through the system's top pharmacy executive, who should be a pharmacist and have a title consistent with those of other leaders reporting at the same organizational level (e.g., chief pharmacy officer). Pharmacy leaders need to be well positioned within an organization to advocate for the pharmacy enterprise and use all resources to the best of their ability. As the scope and complexity of pharmacy services grow, it is critical to ensure that leadership of the pharmacy enterprise is unified under a single pharmacy executive team.

Creating organizational value by leveraging the multihospital pharmacy enterprise.

The results of a survey of multihospital pharmacy leaders are summarized, and a road map for creating organizational value with the pharmacy enterprise is presented. A survey was designed to evaluate the level of integration of pharmacy services across each system's multiple hospitals, determine the most commonly integrated services, determine whether value was quantified when services were integrated, collect common barriers for finding value through integration, and identify strategies for successfully overcoming these barriers. The comprehensive, 59-question survey was distributed electronically in September 2016 to the top pharmacy executive at approximately 160 multihospital systems located throughout the United States. Survey respondents indicated that health systems are taking a wide range of approaches to integrating services systemwide. Several themes emerged from the survey responses: (1) having a system-level pharmacy leader with solid-line reporting across the enterprise increased the likelihood of integrating pharmacy services effectively, (2) integration of pharmacy services across a multihospital system was unlikely to decrease the number of pharmacy full-time equivalents within the enterprise, and (3) significant opportunities exist for creating value for the multihospital health system with the pharmacy enterprise, particularly within 4 core areas: system-level drug formulary and clinical standardization initiatives, supply chain initiatives, electronic health record integration, and specialty and retail pharmacy services. Consistently demonstrating strong organizational leadership, entrepreneurialism, and the ability to create value for the organization will lead to the system-level pharmacy leader and the pharmacy enterprise being well-positioned to achieve positive outcomes for patients, payers, and the broader health system.

Using ASHP fellowship criteria as a template for continuous professional development.

Pharmacy executives are responsible for the operation of their departments as well as for the development of pharmacy teams, the advancement of the profession, and, ultimately, the improvements in patient care and outcomes. The best way to achieve these parallel goals is to create an environment in

ASHP Statement on the Roles and Responsibilities of the Pharmacy Executive.

Journal Article ASHP Statement on the Roles and Responsibilities of the Pharmacy Executive Get access American Journal of Health-System Pharmacy, Volume 73, Issue 5, 1 March 2016, Pages 329–332, https://doi.org/10.2146/ajhp150541 Published: 01 March 2016

Pharmacy innovation across the nation

Pharmacy innovation across the nation