ASHP Foundation Pharmacy Forecast 2022 Strategic Planning Guidance For Pharmacy Departments In Hospitals And Health Systems

PHARMACY FORECAST 2022
AM J HEALTH-SYST PHARM | VOLUME 79 | NUMBER 2 | JANUARY 15, 2022 23
An audio interview that sup-
plements the information in
this article will be available at
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2022
Strategic Planning Guidance
for Pharmacy Departments in Hospitals and
Health Systems
Editor: Joseph T. DiPiro, Pharm.D., FCCP, FAAAS
Dean and Professor, Archie O. McCalley Chair, School of Pharmacy, Virginia
Commonwealth University, Richmond, Virginia
Advisory Committee
John A. Armitstead, M.S., RPh, FFSHP, FKSHP, FASHP
Lee Health, Ft. Myers, Florida
Daniel M. Ashby, B.S.Pharm., M.S., D.Sc. (Hon), FASHP
The Johns Hopkins Health System (retired), Harrisburg, Pennsylvania
Sylvia Belford, Pharm.D., M.S., CPHIMS
Mayo Clinic, Rochester, Minnesota
Jannet M. Carmichael, Pharm.D., BCPS, FCCP, FAPhA
Pharm Consult NV LLC, Reno, Nevada
David Chen, B.S.Pharm., M.B.A.
American Society of Health-System Pharmacists, Bethesda, Maryland
Marie A. Chisholm-Burns, Pharm.D., Ph.D., M.P.H., M.B.A., FCCP,
FASHP, FAST
University of Tennessee, Memphis, Tennessee
Daniel J. Cobaugh, Pharm.D., DABAT, FAACT
American Society of Health-System Pharmacists, Bethesda, Maryland
Francesca Cunningham, Pharm.D.
Department of Veterans Affairs (VACO), Hines, Illinois
Monika N. Daftary, PharmD, BCPS AQ-ID, AAHIVP
Howard University, Washington, D.C.
Melanie A. Dodd, Pharm.D., Ph.C., BCPS, FASHP
The University of New Mexico, Albuquerque, New Mexico
Toni Fera, B.S. Pharm., Pharm.D.
Project Consultant, Greater Pittsburgh Area, Pennsylvania
Christopher R. Fortier, Pharm.D., FASHP
Massachusetts General Hospital, Boston, Massachusetts
James M. Hoffman, Pharm.D., M.S., BCPS, FASHP
St. Jude Children’s Research Hospital, Memphis, Tennessee
Vivian Johnson, B.S. Pharm., Pharm.D.,M.B.A., RPh, FASHP
Parkland Health and Hospital System, Dallas, Texas
Leyner Martinez, Pharm.D., M.S., M.H.A., FACHE
Baptist Hospital of Miami, Baptist Health South Florida, Miami, Florida
Barbara B. Nussbaum, B.S.Pharm., Ph.D.
ASHP Research and Education Foundation, Bethesda, Maryland
Binita Patel, Pharm.D., M.S.
Memorial Hermann Health System, Houston, Texas
Rita Shane, Pharm.D., FASHP, FCSHP
Cedars-Sinai Medical Center, Los Angeles, California
Elva Angelique Van Devender, Ph.D, Pharm.D., BCPS, DPLA
Providence Health & Services, Oregon Region, Portland, Oregon
Michelle D. Wiest, Pharm.D., BCPS, FASHP
UC Health, Cincinnati, Ohio
Tom Woller, M.S., FASHP, RPh
President, TWWRX, LLC, Fort Myers, Florida
The bibliographic citation for this report is as follows: DiPiro JT, et al.
Pharmacy forecast 2022: strategic planning advice for pharmacy
departments in hospitals and health systems.
Am J Health-Syst Pharm. 2022;79:23-51.
Address correspondence to Dr. DiPiro (jtdipiro@vcu.edu)
This article is available freely at https://academic.oup.com/ajhp.
Keywords: drug therapy trends, forecasting, health-system trends, patient
care trends, pharmacy leadership, pharmacy workforce, strategic planning
https://doi.org/10.1093/ajhp/zxab355
Open access
Creation of the Pharmacy Forecast 2022 report was supported by an
unrestricted donation from Omnicell, Inc., to the David A. Zilz Leaders for
the Future Fund of the ASHP Foundation.
Foreword
ASHP and the ASHP Foundation (“the Foundation”) present this
10th edition of the annual Pharmacy Forecast and are pleased to dis-
seminate it through AJHP, providing readers with easy access to the
report. The ASHP Foundation Pharmacy Forecast has a long tradition
ofprovidinginsightfulperspectiveoninternalandexternalfactorsthat
influence patient care, the health of populations, and our profession.
The Pharmacy Forecast is a product of efforts from many individ-
uals. Founding editor William Zellmer initiated the project and then
guided the report through the first 4 editions. The Pharmacy Forecast
could not continue without the contributions of members of the
Forecast 2022 Advisory Committee, Forecast Panelists who responded
tothesurvey,andthechapterauthors.ASHPandtheASHPFoundation
are indebted to those individuals who have helped make the 2022 edi-
tion a success. The staff of AJHP has provided substantial editorial sup-
port for this publication, and we appreciate their assistance.
As the philanthropic arm of ASHP, the Foundation supports the
pharmacy workforce by funding research and education to improve
health outcomes through optimal medication use and demonstrate
pharmacy’s impact. Through the Pharmacy Forecast ASHP and the
Foundation assist pharmacy leaders as they navigate through devel-
opments in key areas of opportunity or challenge over the next 5 years.
The Pharmacy Forecast provides insights into emerging trends
and phenomena that have affected or could affect the practice of
pharmacy and the health of patients across the health system. While
the primary application of the report is for health-system pharmacists
and health-system pharmacy leaders to inform their strategic plan-
ning efforts, the report can also be useful to inform decision makers
about likely influencers over the next 5 years. New to this edition,
assessments of pharmacy preparedness for external challenges are
provided. Combining both the assessment of likelihood for various
statements as well as pharmacy preparedness within the survey pro-
vides a useful perspective on important issues.
The Pharmacy Forecast is not intended to be an accurate predic-
tion of future events. Rather, the report is intended to be a provocative
stimulant for the thinking, discussion, and planning that must take
place in every hospital and health system in order for leaders to be in-
formedandfortheirorganizationstosucceedintheirmissionofcaring
for patients, addressing the health of populations, and advancing the
profession of pharmacy. Some may disagree with the opinions of the
Forecast Panelists or the positions taken by individual chapter authors
with respect to their interpretations and extensions of the survey data.
That is acceptable and desirable. Also, the report reflects a consensus
of the national direction and may not reflect what is likely to occur in
your geographic region or state. Reflect those differing opinions in
your organization’s strategic planning process and chart a course for
your organization that is consistent with your institution’s priorities,
and the Pharmacy Forecast will have met its objective of encouraging
planning efforts of health systems.
We welcome your comments on the 2022 edition of the Pharmacy
Forecast. Suggestions for future forecasts can be sent to any of the
Forecast editors through the Foundation’s Pharmacy Forecast website at
https://www.ashpfoundation.org/research/pharmacy-forecast and will
beconsideredforfutureeditions.
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PHARMACY FORECAST 2022 INTRODUCTION AND METHODS
Introduction and Methods
Emerging from the COVID-19 pan-
demic and the social injustice of the
past few years, our eyes have opened to a
different world. The focus of this edition
of Pharmacy Forecast acknowledges that
world. The key themes in this Forecast
report—value, access, disparity, equity,
resilience, agility, and preparedness—are
much different from the technical, clin-
ical, and financial terms prominent in
past editions. All of these terms impact
our traditional world of pharmacy, and
so, in this edition, we are considering
how they influence the pharmacy en-
terprise, digital health and remote care,
social determinants of health, public and
population health, professional roles of
the pharmacy team, and employee well-
being. Our job as pharmacy leaders has
changed, in that proficiency in technical
and financial aspects of job performance
are necessary but not sufficient. We must
better understand the social environ-
ment in which our services are provided.
The perspective gained from
reading the 2022 Pharmacy Forecast
can be used within the process of stra-
tegic planning as part of environmental
scanning or when identifying strengths,
weaknesses, opportunities, and threats
(SWOT). It can also be used as part of
leadership, staff, and trainee develop-
ment. The dynamic nature of the factors
discussed here suggests that traditional
3- to 5-year strategic planning may
need to be replaced with more nimble
and timely planning processes that are
integrated into ongoing leadership ac-
tivity. The recommendations provided
below can be part of the institution’s
strategic plan action steps.
FORECAST METHODS
The methods used to develop the
2022 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 individ-
uals in which each participant’s input
is provided independently, drawing
from their own locally informed points
of view—can be more informative than
the opinion of any individual partici-
pant. This process is particularly valu-
able when addressing phenomena that
are not well suited to quantitative pre-
dictive methods. A critical requirement
for successfully creating crowd-based
knowledge is establishing a system-
atic method of combining individual
beliefs into a collective opinion—and
the Pharmacy Forecast uses a survey of
carefully selected pharmacy leaders to
derive our environmental scan.
The 2022 Pharmacy Forecast
Advisory Committee (see membership
list in the Foreword) began the devel-
opment of survey questions by contrib-
uting lists of issues and concerns they
believed will influence health-system
pharmacy in the coming 5 years. That
list was then expanded and refined
through an iterative process, resulting
in a final set of 4 general themes, each
with 10 focused statements on which
the survey was built. A fifth theme dealt
with assessments of “preparedness” for
8 selected statements from the 4 gen-
eral theme areas. Each of 48 survey
items was pilot tested to ensure clarity
and face validity.
As in the past, Pharmacy Forecast
survey respondents—the Forecast
Panelists (FPs)—were selected by ASHP
staff after nomination by the leaders of
the ASHP sections. Nominations were
limited to individuals known to have
expertise in health-system pharmacy
and knowledge of trends and new de-
velopments in the field. The size of
and representation within the Forecast
Panel was intended to capture opinions
from a wide range of pharmacy leaders.
The Forecast survey instructed FPs
to read each of the 40 statements repre-
sented in survey items for the 4 general
theme areas and consider the likeli-
hood of those scenarios occurring in
the next 5 years within their domain.
They were asked to provide a top-of-
mind response regarding the likeli-
hood of those conditions being very
likely, somewhat likely, somewhat un-
likely, or very unlikely to occur. Then,
FPs assessed the preparedness (from
very unprepared to very prepared) for
8 statements. They were asked to base
their response on their firsthand know-
ledge of current conditions in their re-
gion, not on their understanding of
national circumstances. The panel was
carefully balanced across the census
regions of the United States to reflect a
representative national picture.
FORECAST SURVEY RESULTS
The strength (and possibly val-
idity) of predictions generated using
the “wisdom of the crowd” method is
largely dependent on the nature of the
panelists responding to the forecast
survey. Therefore, it is important to
understand the composition and char-
acteristics of the panel.
A total of 387 FPs were recruited
to complete the forecast survey.
Responses were received from 311 (an
80.4% response rate, similar to the re-
sponse rate in previous years). Most of
the FPs (79%) had been in practice for
greater than 10 years, and 46% had been
in practice for greater than 20 years.
Forty-six percent of FPs described their
practice setting as a teaching hospital
or health system, while 10% of FPs were
from nonteaching hospitals or health
systems. Twenty-two percent were from
academia, similar to the previous year.
Joseph T. DiPiro, Pharm.D., FCCP,
FAAAS, Dean, School of Pharmacy,
Virginia Commonwealth University,
Richmond, Virginia, USA
Address correspondence to Dr. DiPiro
(jtdipiro@vcu.edu).
© American Society of Health-System
Pharmacists 2021. All rights reserved.
For permissions, please e-mail: journals.
permissions@oup.com.
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INTRODUCTION AND METHODS PHARMACY FORECAST 2022
Many of the FPs hold the title of
chief pharmacy officer, director of
pharmacy, or associate/assistant dir-
ector of pharmacy (11%, 13%, and 8%
of FPs, respectively). Seventeen per-
cent of FPs listed their primary position
as “clinical pharmacist” (generalist or
specialist) or “clinical coordinator.”
Another 22% described their primary
role as “faculty.” The remainder of FPs
included leaders and practitioners at
varying levels and with varying titles.
Fifty-two percent of FPs were employed
by hospitals with 500 or more beds,
and 23% of respondents were from
hospitals of less than 500 beds. Overall,
the composition of the Panel was
similar to previous years. As shown in
Table 1, the percent of total responses
from each U.S. region ranged from 5%
in the New England, Middle South, and
Mountain regions to 22% in the Great
Lakes region. In the 2022 survey, each
of the 4 regions was represented by a
minimum of 46 FP respondents.
CONTENTS OF THE 2022
PHARMACY FORECAST
Each section of the report provides a
summary of the survey findings, assess-
ment and perspective of the chapter
authors, and strategic recommenda-
tions. While the individual survey items
focus on a specific projection of the fu-
ture, the full breadth of discussion in
each chapter is broad and links related
items when appropriate. The individual
chapters explore the broad concepts
of value, access and equity, agility and
resilience, workforce capability, and
preparedness.
The first chapter, by Jannet Car-
michael and Vivian Johnson, is
“Delivering Value to Stakeholders.”
While there is a consensus for the ex-
pectation of value in healthcare, the
definition of value varies with stake-
holder perspective. The authors de-
scribe this perspective from a global,
health system, population, and patient
level along with the opportunities to
demonstrate value at each level.
The issues of access to healthcare,
health disparities, and health equity
have emerged over the past few years,
while solutions remain elusive. In the
chapter “Impacting Access, Disparities,
and Equity,” Monika Daftary and
Leyner Martinez address the role of the
pharmacist in public health and com-
munity partnerships as a mechanism to
better serve underserved populations.
Progress can also be possible through
the use of data analytics and communi-
cation technology.
Michelle Wiest and Binita Patel
have addressed the topic “Reimagining
Health Systems for Agility and
Resilience,” examining the responses to
change, disruption, and maintenance
of core functions. The topic includes
key questions about the role of phar-
macists and health systems, remote
care and interprofessional team care
models, data analytics, and drug supply
continuity.
Pharmacy workforce continues to be
a major topic for planning in the years
ahead.TomWollerandElvaVanDevender
address workfoce-related issues in the
article “Building the Foundation of the
Pharmacy Enterprise: Assuring Workforce
Capability.”Theyexplorehowremotecare
and remote work may impact the phar-
macy workforce and describe how phar-
macy technicians may become more
involvedinpatientcaresupportservices.
The final chapter, “Pharmacy Pre-
paredness for Change,” by Rita Shane
and Francesca Cunningham, explores
the cross-cutting issue of prepared-
ness as it relates to growth of the phar-
macy enterprise, pharmacists serving as
healthcare providers, advancing tech-
nician roles, and social determinants of
health and disparities. In addition, they
discuss the findings that a majority of re-
spondents reported that it was likely that
pharmacists are prepared to manage
chronic conditions from health data
generated remotely, and that health
systems are prepared to respond to
emerging public health challenges.
USER’S GUIDE TO THE
PHARMACY FORECAST
The focus of Pharmacy Forecast is
on large-scale, long-term trends that will
influence us over months and years and
not on day-to-day situational dynamics.
The 2022 edition of the Pharmacy
Forecast addresses continuing issues of
importance such as the pharmacy en-
terprise, workforce and the role of tech-
nicians, and use of data, as they intersect
with issues such as value to stakeholders,
health equity, response to external chal-
lenges, and preparedness for change.
The report is intended to stimulate
thinking and discussion, providing a
starting point for individuals and teams
who wish to proactively position them-
selves and their teams and depart-
ments for potential future events and
trends rather than be reactive to those
things that occur.
As the process of strategic plan-
ning should involve pharmacy staff
at all levels, the Pharmacy Forecast
provides guidance to anyone
participating in health-system
Table 1. Forecast Survey Responses by Region
Region Percent of 311 Total Responses
New England (ME, NH, VT, MA, RI, CT) 5
Mid-Atlantic (DE, NY, NJ, PA) 9
South Atlantic (MD, DC, VA, WV, NC, SC, GA, FL) 18
Southeast (KY, TN, AL, MS) 11
Great Lakes (OH, IN, IL, MI, WI) 22
Western Plains (MN, IA, MO, ND, SD, NE, KS) 14
Middle South (AR, LA, OK, TX) 5
Mountain (MT, ID, WY, CO, NM, AZ, UT, NV) 5
Pacific (WA, OR, CA, AK, HI) 8
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PHARMACY FORECAST 2022 INTRODUCTION AND METHODS
strategic planning activities, and it is
recommended that the report be re-
viewed by all involved.
When using the Pharmacy
Forecast, planners should review
past editions in addition to this new
report; many of the observations
and recommendations that are 1 or
2 years old remain important to con-
sider. Past editions of the Pharmacy
Forecast can be found on the ASHP
Foundation website at https://
www.ashpfoundation.org/research/
pharmacy-forecast.
Those organizations involved in edu-
cationortrainingshouldconsidertheuse
of the Pharmacy Forecast as a teaching
tool. Many educators and residency pre-
ceptors use the report as part of course-
work, seminars, or journal club sessions
to help engage pharmacy trainees in
thinking about the future of the profes-
sion they are preparing to enter.
Finally, as the pharmacy workforce
is increasingly relied upon to provide
system-wide leadership, the Pharmacy
Forecast addresses many issues that
are relevant well beyond the trad-
itional boundaries of pharmacy and
the medication-use process. The con-
tent of the report should inform the
broadened scope of responsibility
that many pharmacists now have. The
Pharmacy Forecast should be shared
with other senior health-system
leaders and executives as a resource to
help them understand the challenges
facing pharmacy and to help them rec-
ognize the way emerging healthcare
trends will affect many other areas of
health systems.
Disclosures
Dr. DiPiro serves on the AJHP Editorial
Advisory Board. He has declared no potential
conflicts of interest.
Reference
1. Surowiecki J. The Wisdom of Crowds.
Anchor; 2005.
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DELIVERING VALUE TO STAKEHOLDERS PHARMACY FORECAST 2022
Delivering Value to Stakeholders
INTRODUCTION
Value is that which is good, desirable,
or worthwhile from the perspective
of the stakeholder. Healthcare value can
be defined in terms of health outcomes
per dollar spent. Everyone who receives,
pays for, or provides healthcare expects
value to be the delivered outcome.
Consumers, patients, countries, health
systems, provider networks, healthcare
professionals, and healthcare payers are
all value stakeholders.1
Expecting value
in healthcare may seem obvious, but
one’s perspective on the outcome may
be measured differently by each stake-
holder.2
Delivering value is dependent
on the perspective of the stakeholder,
the ability to define the health outcome
desired as well as the cost to deliver
it, and finally, the ability to accurately
measure both.
Healthcare organizations involved
in performance and payment are
developing and using metrics more
often to measure health outcomes as
surrogates for completed interven-
tions, to give recognition, measure
processes and quality, and award re-
imbursement. These organizations
and metrics are driving accountability
and value-based reimbursement de-
cisions for healthcare. Pharmacists
are involved in delivering the care and
achieving the goals for many of these
metrics.3
Because of the increasingly
complex nature of the pharmacy en-
terprise, innovative pharmacy leaders
must find opportunities to provide
value in new ways to be recognized as
delivering high value beyond medica-
tion management.4,5
Over the last 40 years, pharmacy
has evolved into the clinical profes-
sion whose “fundamental purpose is to
serve as a force in society for safe and
appropriate use of drugs.”6
Pharmacy
has demonstrated value in improving
medication management as a necessary
part of healthcare. Direct patient care
encounters have led many pharmacists
to be recognized as independent clin-
ical practitioners in health systems and
demonstrating measurable improve-
ment in patient outcomes.7,8
In addition
to improving patient outcomes, phar-
macists are increasingly accountable for
medication-related services, e.g., prior
authorization, criteria for use and order
set development, outcome utilization
reviews,andindividualcasereviewsthat
have evolved from traditional formu-
lary management. More sophisticated
pharmacovigilance programs demon-
strate value by focusing on improving
safe and appropriate medication use.9
Because of the value of these processes
to the health-system, these strategies
are now being expanded and applied
to other areas such as specialty medi-
cations, gene therapies, devices and
supplies, and patient digital care tech-
nologies. As a result, more pharmacists
will need to be intentional and see this
as an opportunity to lead and take re-
sponsibility for contributions to add
value in these areas and support inte-
grated patient care.
A logical expansion of these
untapped opportunities exists in
population health management by
pharmacists that measures quality,
safety, and value outcomes in popu-
lations of patients.10
The use of data
analytics, metrics, technology, and
electronic medical record data for
population management by pharma-
cists continues to demonstrate im-
proved health outcomes and value to
the health system.11
GLOBAL VALUE OF
PHARMACISTS
Forecast panelists (FPs) were asked
if health systems will be at financial
risk and if reimbursement for clin-
ical care services through value-based
contracts will be common (in >50%
of patients) (Figure 1, items 8 and 9).
Forecast participants were split on
their responses, with about two-thirds
saying very or somewhat likely. This
may be the overarching value question
for society at large. Will patients and
payers demand and will healthcare sys-
tems achieve better health outcomes
per dollar spent? The difficultly will
likely be in the details of defining so-
cietal healthcare goals and perform-
ance improvement worth paying for,
especially in one budget cycle. FPs
were encouraging, with two-thirds re-
sponding pharmacists would be des-
ignated as healthcare providers by the
Centers for Medicare and Medicaid
Services in the next 5 years (Figure 1,
item 10), which will increase recogni-
tion of pharmacists for the contribution
to positive outcomes they are providing
and help assign accountability to the
pharmacy profession.
SYSTEM-LEVEL VALUE OF
PHARMACISTS
One survey item stated that phar-
macy departments will provide signifi-
cant contributions to health systems’
revenue and market share with new
service lines or business ventures; and
92% of the FPs indicated it was likely
(Figure 1, item 1). When asked if new
services will increase market share
and system revenue, fewer respond-
ents (79%) thought this was very or
somewhat likely (Figure 1, item 2).
When asked if pharmacy leaders were
prepared to increase service lines and
new business ventures to increase
market share and revenue, panelists
were less likely to agree (Figure 5, item
1). Pharmacy leaders seem to recog-
nize they will be asked to make more
Jannet M. Carmichael, B.S. Pharm.,
Pharm.D., BCPS, FACCP, FAPhA,
President, Pharm Consult NV LLC, Reno,
NV, USA
Vivian B. Johnson, Pharm.D., M.B.A.,
RPh, FASHP, Senior Vice President of
Clinical Services, Parkland Health and
Hospital System, Dallas, TX, USA
Address correspondence to Dr.
Carmichael (jannetcarmichael@gmail.
com).
Published by Oxford University Press on
behalf of the American Society of Health-
System Pharmacists 2021.
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PHARMACY FORECAST 2022 DELIVERING VALUE TO STAKEHOLDERS
Figure 1. (Delivering Value to Stakeholders). Forecast Panelists’ responses to the question, “How likely is it that the
following will occur, by the year 2026, in the geographic region where you work?”.
19% 41% 38%
Pharmacy leaders will add new service lines or business ventures that increase market share and revenue.
VERY UNLIKELY SOMEWHAT UNLIKELY SOMEWHAT LIKELY VERY LIKELY
In 75% of health systems, the department of pharmacy will provide a significant contribution to
health system revenue.
50% of health systems will allocate more pharmacy staff to provide medication management to improve
population health.
Health-system pharmacies will be recognized as preferred site of care for the delivery of complex,
new therapies (e.g. gene therapies, CAR-T therapy, and other specialty therapies).
50% of health systems will have specialized staff dedicated to pharmacy enterprise data analytics.
4% 19% 53% 24%
1
2
3
4
5
2%
8% 40% 52%
26% 52% 21%
1%
4% 23% 44% 29%
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26% 49% 22%
In 50% of health systems, pharmacy leads the design of strategies for managing the financial impact
of high cost medications.
Health systems will invest in digital health solutions and artificial intelligence technology to improve
medication management.
At least 50% of patient care services will be reimbursed via value-based contracts.
Health systems will be at financial risk for 50% of their attributed patient population.
Pharmacists will be designated as healthcare providers by the Centers for Medicare and Medicaid Services.
6
7
8
9
10
3%
6% 40% 54%
6% 31% 51% 12%
7% 27% 49% 17%
28% 54% 15%
3%
Continued from previous page
Figure 1. (Delivering Value to Stakeholders). Forecast Panelists’ responses to the question, “How likely is it that the
following will occur, by the year 2026, in the geographic region where you work?”.
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PHARMACY FORECAST 2022 DELIVERING VALUE TO STAKEHOLDERS
contributions to system revenue but
are less confident in their prepared-
ness to deliver on that expectation.
Pharmacy will need to push beyond the
boundaries of drug cost containment
into other direct patient-centered care
areas that change pharmacy’s impact
on value to healthcare. Innovations,
such as development and contribution
to new models of care (e.g., direct pa-
tient care to specialty care, ambulatory
care, population health, and transitions
of care) may become performance
expectations for pharmacy leaders
(Figure 3, item 4)
AlmostalloftheFPs(94%)indicated
the likelihood that the majority of the
health systems will look to pharmacy
to design strategies for managing the
financial impact of high-cost medica-
tions (Figure 1, item 6). However, fewer
(77%) reported it likely that pharmacies
will be the preferred site for managing
the delivery of complex, new therapies
(i.e., gene therapies, CAR-T therapy,
and other specialty therapies) (Figure 1,
item 4). These newer therapies rep-
resent opportunities for pharmacy
leaders in health systems to expand
proven and successful solutions using
their expertise in the operational, fi-
nancial, and clinical perspectives of
healthcare. As new therapies become
more specific and customized, phar-
macy leaders must step up and assume
this role to ensure a voice in and align-
ment with the overall health system’s
strategic plan.
The COVID-19 pandemic forced
health systems to use digital health so-
lutions and artificial intelligence (AI) to
improve many aspects of healthcare.12
Health systems will continue to trans-
form the way clinical services are pro-
vided to patients, virtually or remotely.
Seventy-one percent of the FPs agreed
that investment in digital solutions
and AI would be required to improve
medication management, leaving 29%
who responded health systems would
not invest in these solutions (Figure 1,
item 7). Health systems must invest
in technology that can safely replace
human input to provide consistent and
efficient clinical care and allow health
systems the opportunity to redeploy
pharmacists into the community and
impact population and public health.
PATIENT-LEVEL VALUE OF
PHARMACISTS
As more pharmacy and medical
tasks are linked to digital health solu-
tions or AI (Figure 4, item 5) and phar-
macists’ interventions are recorded in
the electronic health record, it is im-
portant that pharmacy leaders also rec-
ognize the importance of specialized
staff dedicated to pharmacy enterprise
data analytics (Figure 1, item 5). These
individuals are critical to the measure-
ment and documentation of value by
recording performance improvement
and associated costs—the scorekeepers
or evidence producers.
FPs agreed that the desire to im-
prove medication management in
populations will drive increased allo-
cations of pharmacist to these tasks
(Figure 1, item 3). Technology, new
pharmacy service lines, and revenue
streams must be prioritized for this ef-
fort. If additional revenue can be real-
ized from new areas, funds may be
available to hire new staff. If not, it may
be necessary to shift existing resources
to population health efforts and other
new value streams. Efforts to improve
efficiency through the use of digital so-
lutions and advanced technology can
help avoid any negative impact on pa-
tient care by this shift.
Disclosures
Dr. Carmichael serves on the AJHP Editorial
Advisory Board. Dr. Johnson serves on the
ASHP Board of Directors. The authors have
declared no other potential conflicts of
interest.
References
1. Institute of Medicine. Vital Signs: Core
Metrics for Health and Healthcare
Progress. National Academies Press;
2015. Accessed August 12, 2021.
https://www.nap.edu/visualizations/
vital-signs/
2. Blumenthal D, Stremikik K. Getting
real about health care value.
Harvard Business Review. Published
September 17, 2013. Accessed May
26, 2021. www.hbr.org/2013/09/
getting-real-about-health-care-value
3. Carmichael JM, Gurbinder J,
Nguyen PA. Healthcare metrics: where
do pharmacists add value? Am J Health-
Syst Pharm. 2016;73:1537-1547.
STRATEGIC RECOMMENDATIONS FOR PRACTICE LEADERS
1. Pharmacy leaders should have
an active role on the health
system’s executive/senior ad-
ministrative leadership team(s)
that reflects their authority and
accountability for medication
management systems perform-
ance and clinical care value
across the organization.
2. Pharmacy leaders should ex-
pand enterprise-level advanced
scopes of practice and clinical
privileging for a high percentage
of clinical pharmacy staff to pre-
pare for advanced independent
provider status in each state. This
will recognize the pharmacist as
a provider of care that supports
the organization’s quality, rev-
enue, and performance strategy.
3. Define, establish, and com-
municate the role pharmacists
play in population health ini-
tiatives to improve outcomes
for the health system and its
patients.
4. Recruit, resource, and expand
a team of pharmacist health in-
formatics professionals trained
in data analytics to ensure ac-
curate value calculations for
pharmacy outcomes.
5. Accelerate the use of digital so-
lutions and artificial intelligence
technology to advance con-
sistent and efficient patient care
and enhance the skills required
by the pharmacy workforce to
maximize use.
6. Develop and manage new
servicelinesorbusinessventures
by pharmacy that demonstrate
value and significantly impact
the organization’s bottom line.
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4. Wilt VM, Gums JG, Ahmed OL, et al.
Outcome analysis of a pharmacist-
managed anticoagulation service.
Pharmacotherapy. 1995;15:732-739.
5. Anaya JP, Rivera JO, Lawson K, et al.
Evaluation of pharmacist-managed
diabetes mellitus under a collaborative
drug therapy agreement. Am J Health-
Syst Pharm. 2008;65:1841-1845.
6. Ray MD. Personal reflections 30 years
after the Hilton Head Conference. Am J
Health-Syst Pharm. 2015;72:972-976.
7. Kaboli PJ, Hoth AB, McClimon BJ,
Schnipper JL. Clinical pharma-
cists and inpatient medical care: a
systematic review. Arch Intern Med.
2006;166(9):955-964.
8. Aspinall SL, Sales MM, Good CB, et al.
Pharmacy benefits management in
the Veterans Health Administration
revisited: a decade of advancement,
2004-2014. J Manag Care Spec Pharm.
2016;22(9):1058-1063.
9. Shermock KM, ed. Theme issue:
population health manage-
ment. Am J Health-Syst Pharm.
2017;74:1398-1485.
10. Carmichael JM, Meier J, Robinson A,
Higgins D, Patel S. Leveraging electronic
medical record data for population
health management in the Veterans
Health Administration: successes
and lessons learned. Am J Health-Syst
Pharm. 2017;74:1447-1459.
11. Carmichael JM, Meier J. Pharmacy
analytics and use of big data. Am J
Health-Syst Pharm. 2021;482-424.
12. McCarthy C, Bateman MT Jr,
Henderson T, Jean R, Evans R.
Adoption of telepharmacy within a
community health center: a focus
on clinical pharmacy services. J Am
Coll Clin Pharm. Published online
July 2, 2021. https://doi.org/10.1002/
jac5.1500
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PHARMACY FORECAST 2022 ACCESS, DISPARITIES, AND EQUITY
Impacting Access, Disparities, and Equity
INTRODUCTION
The need to address healthcare ac-
cess, disparities, and equity in the
United States has been pushed to the
forefront recently as a result of the
COVID-19 pandemic. Examples of
limited access to care have been abun-
dant, especially with the initial rollout
of the COVID-19 vaccines and dis-
ruption of healthcare in communities
across the United States and globally.
Inattention to these issues continues to
weigh heavily on our healthcare system.
Pharmacists and pharmacy techni-
cians are accessible, uniquely skilled,
and positioned to address the interplay
between social determinants of health
(SDOH), access to care, health dispar-
ities, and health equity. They can im-
prove patient outcomes and population
health. However, policy changes (e.g.,
adoption of provider status for pharma-
cists) are required to optimize the role
of pharmacists, especially in vulnerable
populations with limited access to other
healthcare providers and services.
PUBLIC HEALTH: THE ROLE
OF PHARMACISTS AND
PHARMACY TECHNICIANS
Although pharmacists have had
a long-standing role in public health,
only about half of Forecast Panelists
(FPs) indicated that pharmacists
and pharmacy technicians will
systematically screen for SDOH
(Figure2,item1).However,pharmacists
have traditionally addressed SDOH in
populations with health disparities,
especially in community settings, but
not systematically. Screening for SDOH
has demonstrated value in improving
patient outcomes, decreasing medical
expenditures, and improving medica-
tion optimization when pharmacists
consider SDOH as part of the patient
care process.1,2
While pharmacists and
pharmacy technicians can be engaged
in SDOH screening and play a role in
improving patient health, adequate
training, support, and guidance must
be provided.3
Also, 64% of FPs expect
that standard measures will be devel-
oped and widely used to assess equity
of care across a population (Figure 2,
item 6). As healthcare systems en-
deavor to identify where health dispar-
ities exist, pharmacy leaders will need
to work collaboratively with key stake-
holders to create and develop standard
measures for equitable access to medi-
cations and pharmacy services.
Eighty-seven percent of FPs expect
that health systems will partner with
community organizations to address
healthcare disparities in their commu-
nities (Figure 2, item 4). Partnerships
with local departments of health and
grant funding agencies can provide
a mechanism to address medically
underserved populations and facili-
tate solutions to healthcare disparities.
For example, an academia-community
partnership for medication therapy
management improved health indi-
cators and reduced health dispar-
ities in rural, underserved patients.4
Partnerships allow for creation of novel
mechanisms to address health dispar-
ities and health inequity. Pharmacy
departments should be encouraged to
engage with local health departments
and other granting agencies to develop
new approaches to improve health in
underserved populations.
USE OF TECHNOLOGY,
PHARMACIST CARE, AND
ADDRESSING DISPARITIES
Seventy-three percent of FPs indi-
cated that advanced data analytics will
be used by health systems to address
healthcare disparities (e.g., popu-
lation cultural preferences, digital
divide, prevention measures) (Figure 2,
item 3). As the use of advanced data
analytics and artificial intelligence has
increased in healthcare, the potential
benefits of algorithms for screening
and managing chronic conditions have
become more evident. Data analytics
should be considered as part of the
overall approach to health disparities.
However, analytic algorithms are not
usually created with health equity and
may not take into consideration di-
verse patient populations. Hence, data
analytics has the potential to create
biases that could exacerbate existing
health disparities.5
Health systems
need to ensure that data retrieved from
these types of advanced models are in-
clusive of all populations.
Sixty-two percent of FPs indicated
that communication technology (e.g.,
Alexa, Google Assist, healthcare apps)
will allow all patients to have access to
a pharmacist for medication educa-
tion and counseling (Figure 2, item 7).
The COVID-19 pandemic has pushed
to the forefront the need for more ac-
cessible and more effective commu-
nication technologies in healthcare.6,7
However, the lack of technological ac-
cess and literacy negatively affected
underserved populations during
COVID-19 vaccine distribution.7
Voice-assisted technology is already
being incorporated in healthcare—for
example, in diabetes management,
medication management, and refill re-
minders.6
Pharmacy leaders will need
to advocate for equitable access to
digital tools in order to ensure under-
served populations reap the benefits
of technological advances.
Monika N. Daftary, Pharm.D.,
BCPS-AQ ID, AAHIVP, Professor
& Chair, Department of Clinical &
Administrative Pharmacy Sciences,
Howard University, College of Pharmacy,
Washington, DC, USA
Leyner Martinez, Pharm.D., M.S.,
M.H.A., FACHE, Director of Pharmacy
Services, Baptist Hospital of Miami |
Baptist Health South Florida, Miami, FL,
USA
Address correspondence to Dr. Daftary
(mdaftary@howard.edu).
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ACCESS, DISPARITIES, AND EQUITY PHARMACY FORECAST 2022
Figure 2. (Impacting Access Disparities and Equity). Forecast Panelists’ responses to the question, “How likely is it
that the following will occur, by the year 2026, in the geographic region where you work?”
Pharmacists and pharmacy technicians will systematically screen patients for social determinants of health.
In at least 50% of health systems, pharmacists will work as primary care providers.
Advanced data analytics will be used by health systems to address healthcare disparities
(e.g., population cultural preferences, digital divide, prevention measures).
Health systems will partner with community organizations to address healthcare disparities
in their communities.
Payers will link value-based payments to improving health equity measures.
1
2
3
4
5
%
0
2
%
3
5
%
4
2
3%
%
8
%
3
4
%
2
4
%
7
%
5
%
8
2
%
7
4
%
9
1
1% %
4
3
%
3
5
%
2
1
%
9
1
%
2
5
%
7
2
2%
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Standard measures will be developed and widely used to assess equity of care across the population.
Communication technology (e.g., Alexa, Google Assist, healthcare apps) will allow all patients to have access
to a pharmacist for medication education and counseling.
The U.S. public health infrastructure will expand roles for pharmacists in preparedness planning,
vaccine administration, screening for diseases, and health coaching.
As a part of legislation limiting “surprise” medical bills, pharmacists will be required to advise patients
on medication affordability and assistance options.
Health insurance coverage will expand to the entire U.S. population.
%
3
1
%
0
5
%
2
3
%
5
6
7
8
9
10
%
6
%
3
2
%
2
4
%
8
2
%
7
1
%
7
4
%
2
3
%
4
%
6
1
%
6
4
%
0
3
%
8
1% %
9
3
%
5
4
%
4
1
Figure 2. (Impacting Access Disparities and Equity). Forecast Panelists’ responses to the question, “How likely is it
that the following will occur, by the year 2026, in the geographic region where you work?”
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ACCESS, DISPARITIES, AND EQUITY PHARMACY FORECAST 2022
EXPANSION OF THE
PHARMACIST’S ROLE IN
PUBLIC HEALTH
Eighty-four percent of FPs indicated
that the U.S. public health infrastruc-
ture will expand roles for pharmacists
in preparedness planning, vaccine ad-
ministration, screening for diseases,
and health coaching (Figure 2, item 8),
while only 33% of FPs indicated that in
at least 50% of health systems, phar-
macists will work as primary care pro-
viders (Figure 2, item 2). Pharmacists
have been involved in vaccination ad-
ministration in many settings and other
areas of public health for decades. This
experience was essential to pharmacy’s
involvement with COVID-19 vaccine
programs in activities ranging from
organizational oversight of mass vac-
cination programs to administering
the vaccines to individual patients. The
2020 Public Readiness and Emergency
Preparedness (PREP) Act and other
public health emergency policies have
allowed for expansion of vaccine ad-
ministration by pharmacy personnel,
authorization to provide COVID-19
testing, and even relaxation of rules for
telehealth. However, these measures
are in effect only as long as the public
health emergency is present. Pharmacy
leaders and pharmacy organizations
must now advocate with policy makers
to make these changes permanent.
PHARMACY ENTERPRISE
AND HEALTHCARE
INSURANCE
Among FPs, only 29% indicated that
health insurance coverage will expand
to the entire U.S. population by 2026
(Figure 2, item 10). According to the
HealthInsuranceCoverageintheUnited
States: 2020 Report, 8.6% of the popula-
tion, or 28 million people, did not have
health insurance at any point during
the year.8
Private health insurance
coverage (employment-based, direct
purchase, etc.) was more prevalent
than public coverage (e.g., Medicare,
Medicaid, and Veterans Affairs),
covering 68% and 34.1% of the popu-
lation at some point during the year,
respectively.8
Lack of health insurance
and medication unaffordability are still
harsh realities in the U.S. healthcare
system. Medical debt is the predom-
inant causal factor in 18% to 26% of all
consumer bankruptcies.9
Pharmacists
can play an essential role in curtailing
the rising cost of healthcare by ensuring
that medications are prescribed ac-
cording to evidence-based guidelines,
reducing inappropriately prescribed
medications, and preventing poten-
tial adverse drug events. Healthcare
leaders will need to deploy more phar-
macistsintransitionsofcarerolestoen-
sure that patients are discharged with
cost-effective medication therapies,
help improve medication adherence,
and prevent hospital readmissions.
Pharmacy leaders need to advocate
for pharmacist-led medication rec-
onciliation programs encompassing
discharge medication counseling and
postdischarge follow-up to reduce
medication errors and provide effective
transitions of care.
Congress enacted the Federal No
Surprises Act that goes into effect on
January 1, 2022, protecting patients
from unexpected and out-of-network
medical bills for emergency care
and ancillary services such as those
of anesthesia providers who are not
in-network during scheduled proced-
ures.10
Sixty-threepercentofFPsagreed
that as a part of legislation limiting
“surprise” medical bills, pharmacists
will be required to advise patients on
medication affordability and manu-
facturer assistance options (Figure 2,
item 9). Pharmacy professionals will
still play a lead role in education and
awareness about pharmaceutical com-
pany–sponsored medication assist-
ance programs. Many health systems
already allocate pharmacy resources
to medication assistance programs.
However, there are still opportunities
for pharmacy leaders to create viable
medication assistance programs ei-
ther outsourced or facilitated within
their organizations. Pharmacists need
to partner with other interdisciplinary
stakeholders (e.g., case managers, care
coordinators, clinical teams) to create
processes that can maximize the use
of financial assistance programs,
including copayment assistance
programs, disease-based patient as-
sistance programs, and drug- or
company-specific patient assist-
ance programs. As pharmacists con-
tinue to expand into ambulatory care
clinics and more specialty pharmacies
emerge, the expansion of pharmacy-
led medication assistance programs is
paramount in order to help reduce pa-
tient out of pocket expenses, thereby
also positioning patients for poten-
tially better treatment adherence.
The elimination of unexpected
medical bills requires payers to develop
1. Include in your strategic plan
actions to have pharmacists
more involved in transitions of
care medication services and as-
sist patients with accessing cost-
effective medication therapies.
2. Allocate pharmacy labor re-
sources to lead medication as-
sistance program access and
assist patients with medication
affordability and adherence.
3. Pharmacists should collaborate
with health plans and state-level
healthcare financing agencies
to continue establishing value-
based care initiatives that include
pharmacist-provided compre-
hensive medication manage-
ment services.
4. Pharmacists should be identi-
fied as patient care providers
to increase access to quality
healthcare for all.
5. Advocate that state and federal
policy changes made during
the pandemic should be made a
permanent part of the scope of
pharmacy practice.
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valued-based arrangements. Most
FPs (71%) agreed that payers will link
value-based payments to improving
health equity measures (Figure 2, item
5). Pharmacists can influence the care
delivery model and push for evidence-
based treatment standards. Pharmacists
must continue to establish pharmacist-
led, value-based care initiatives and
provide comprehensive medication
management services like the California
RightMedsCollaborative,wherebyanet-
work of pharmacists deliver high-impact
medication management services
through a sustainable, value-based pay-
ment model in partnership with health
payers.11
Pharmacy leaders should con-
tinue expanding the role of pharmacists
in ambulatory care settings and support
collaborative efforts with emphasis on
medication therapy management and
chronic disease management and pre-
vention. Generating additional evidence
demonstrating the positive impact of
pharmacist-led, value-based care should
be prioritized by pharmacy leaders.
Pharmacists must continue to be in-
volved in legislative advocacy through
professional organizations and promote
pharmacist-centered value-based initia-
tives leading to positive health outcomes
and reduced healthcare cost. Through
emphasis in quality measures and pa-
tient outcomes, healthcare leaders will
need to support a change in paradigm
whereby providers are incentivized
based on total quality of care and out-
come measures rather than on the quan-
tity of services.
Disclosures
The authors have declared no potential con-
flicts of interest.
References
1. Markus D, Dean S. Tackling social
determinants of health by leveraging
community pharmacies in a national,
scalable model. Presentation at: 2020
Pharmacy Quality Alliance Annual
Meeting; May 13-15, 2020.
2. Pestka DL, Espersen C, Sorge LA,
Funk KA. Incorporating social de-
terminants of health into compre-
hensive medication management:
insights from the field. J Am Coll Clin
Pharm. 2020;3:1038-1047. doi:10.1002/
jac5.1254
3. Dover DC, Belon AP. The health
equity measurement framework: a
comprehensive model to measure
social inequities in health. Int J Equity
Health. 2019;18(1):36. doi:10.1186/
s12939-019-0935-0
4. Johnson M, Jastrzab R, Tate J, et al.
Evaluation of an academic-community
partnership to implement MTM
services in rural communities to
improve pharmaceutical care for
patients with diabetes and/or hyper-
tension. J Manag Care Spec Pharm.
2018;24(2):132-141. doi:10.18553/
jmcp.2018.24.2.132
5. Clark CR, Wilkins CH, Rodriguez JA,
et al. Health care equity in the use
of advanced analytics and artificial
intelligence technologies in primary
care. J Gen Intern Med. Published
online May 23, 2021. doi:10.1007/
s11606-021-06846-x
6. Sezgin E, Huang Y, Ramtekkar U,
et al. Readiness for voice assistants to
support healthcare delivery during a
health crisis and pandemic. NPJ Digit
Med. Published online September
16, 2020. https://doi.org/10.1038/
s41746-020-00332-0
7. Press VG, Huisingh-Scheetz M,
Arora VM. Inequities in technology
contribute to disparities in COVID-19
vaccine distribution. JAMA Health
Forum. 2021;2(3):e210264. doi:10.1001/
jamahealthforum.2021.0264.
8. Keisler-Starkey KB, Bunch LN. Health
Insurance Coverage in the United States:
2020. United States Census Bureau; 2021.
Accessed October 12, 2021. https://www.
census.gov/content/dam/Census/library/
publications/2020/demo/p60-271.pdf.
9. Austin D. Medical debt as a cause
of consumer bankruptcy. Maine
Law Review. Revised November 11,
2015. Accessed July 17, 2021. https://
papers.ssrn.com/sol3/papers.
cfm?abstract_id=2515321
10. Kaiser Family Foundation. Surprise
medical bills: new protections for
consumers take effect in 2022.
Published February 4, 2021. Accessed
July 17, 2021. https://www.kff.
org/private-insurance/fact-sheet/
surprise-medical-bills-new-
protections-for-consumers-take-
effect-in-2022/
11. California Right Meds Collaborative.
Home page. Accessed July 17, 2021.
https://calrightmeds.org/
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AGILITY AND RESILIENCE IN HEALTH SYSTEMS PHARMACY FORECAST 2022
Reimagining Health Systems for Agility and Resilience
INTRODUCTION
Agility and resilience apply to
numerous challenges in the
healthcare environment ranging from
response to disasters to the ability to
advance practice models so that pa-
tient care is improved despite finan-
cial challenges or resource constraints.
Health systems and their workforces
must demonstrate agility, the ability
to be responsive and nimble, to seize
opportunities in a rapidly changing
environment. At an enterprise level,
agility means shifting strategy, struc-
ture, processes, people, and technology
so that an organization can respond
to changes in its environment. The
changes required to be an agile health
system can be challenging, as resist-
ance to change and the innate pref-
erence for a stable environment is a
natural human reaction.1
Successful
healthcare organizations demonstrate
resilience by recovering quickly from
challenges. Resilience is a core concept
in disaster risk reduction, which is the
ability of health systems to prepare for,
recover from, and adapt to disruption
while maintaining core functions and
serving the ongoing healthcare needs
of their patients.2
The intense chal-
lenges healthcare is facing due to the
COVID-19 pandemic have increased
the focus on resilience of healthcare
organizations and workers to continue
providing safe, high-quality care.
PREPAREDNESS
AND RESILIENCE TO
MEET PUBLIC HEALTH
CHALLENGES
Health-system and pharmacy
leaders must be prepared for disasters
and emergencies, including natural
or man-made events such as pan-
demic outbreaks or terrorist attacks,
that may result in organizational and
community-widedisruptions.3
Forecast
Panelists (FPs) indicated that health-
system pharmacists will be essential
providers in regional and national
emergency preparedness response
evaluation and planning (Figure 3, item
1). During the COVID-19 pandemic,
pharmacists demonstrated these cap-
abilities by asserting themselves in
leading the emergency responses to the
pandemic by evaluating emerging drug
therapies to rapidly make patient care
decisions, monitoring and adjusting
COVID-19 medications to prevent ad-
verse side effects, managing numerous
drug shortages, maintaining uninter-
rupted drug supply, adjusting work-
flow to preserve personal protective
equipment, establishing new phar-
macy services in temporary emergency
hospitals, and supporting research to
treat and prevent COVID-19.4
While
continuing to participate in their health
system’s emergency-preparedness
plan, pharmacy leaders must embed
pharmacists and promote participation
in local, regional, and national interdis-
ciplinary public health teams.
The COVID-19 pandemic instigated
unpredictable patient healthcare needs
and reassessment of the healthcare
workforce required to provide patient
care. Seventy percent of FPs responded
that within 5 years pharmacy depart-
ments will have contingency plans for
“right-sizing” of staff in response to sig-
nificant health-system patient volume
shifts (Figure 3, item 3). Challenges
to create these models will be posed
by staff shortages, employee burnout,
needs for staff training, and unestab-
lished metrics for proper pharmacist
and pharmacy technician staffing. As
part of their ongoing preparedness
planning, pharmacy leaders should
evaluate departmental and employee
professional needs as they develop
appropriate staffing plans for public
health emergencies.
The majority of FPs indicated that at
least 90% of health systems will expand
their capacity to respond to emerging
public health challenges (e.g., the
opioid crisis, pandemics, multidrug-
resistant infections) (Figure 3, item 9).
Health systems should focus not only
on adjusting to maintain acute care
needs but also on ensuring continuity
of care for patients with chronic dis-
eases.5
Pharmacy leaders must con-
tinue to monitor the development of
public health challenges to anticipate
service expansion needs to optimize
drug therapies for the best patient
outcomes.
The unknowns in the treatment and
numbers of patients with presumed or
confirmed COVID-19 at the onset of the
pandemic and the absence of stand-
ardized COVID-19 treatment regimens
disrupted the pharmaceutical supply
chain, resulting in drug shortages.5
Manufacturer and wholesaler analysis
of the COVID-19 medication distribu-
tion disruption is needed to improve
production forecasting and implement
dynamic allocation strategies to en-
sure that hospitals or regions in need
will receive appropriate allocations of
medications. FPs were split in their re-
sponse regarding a strategy for health
systems using in-house or regional
continuous manufacturing processes
to mitigate drug shortages (Figure 3,
item 6), whereas 67% indicated that it
was somewhat or very likely that health
systems will collaborate with manu-
facturers to develop demand surge
strategies for drugs and supplies, such
as demand contracting and regional
Michelle D. Wiest, Pharm.D., BCPS,
FASHP, Vice President, Pharmacy
Services, UC Health, Cincinnati, OH, USA
Binita Patel, Pharm.D., M.S. Vice
President, Pharmacy Services, Memorial
Hermann Health System, Houston, TX,
USA
Address correspondence to Dr. Wiest
(michelle.wiest@uchealth.com).
behalf of the American` Society of Health-
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PHARMACY FORECAST 2022 AGILITY AND RESILIENCE IN HEALTH SYSTEMS
Figure 3. (Reimagining Health Systems for Agility and Resilience). Forecast Panelists’ responses to the question,
“How likely is it that the following will occur, by the year 2026, in the geographic region where you work?”.
Health system pharmacists will be essential providers in regional and national emergency preparedness
response evaluation and planning.
Health system pharmacists will be managing chronic conditions from health data generated remotely
(e.g., from wearable or telehealth applications) in 50% of ambulatory patients.
In at least 50% of hospitals, the pharmacy department will have contingency plans for “right-sizing” of staff in
response to significant health system patient volume shifts.
In at least 75% of health systems, interprofessional teams will adopt agile “pod” structures (e.g. medical
home, specialty services) that include pharmacists.
1
2
3
4
5
11% 40% 37% 12%
Innovations, such as development of new models of care and services, will be a performance expectation
of pharmacy leaders in health systems.
2% 12% 52% 35%
4% 25% 49% 21%
16% 58% 23%
2%
4% 40% 44% 11%
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At least 25% of health systems will use in-house or regional continuous manufacturing processes
to mitigate drug shortages.
Health systems will collaborate with manufacturers to develop demand surge strategies for drugs
and supplies, such as demand contracting and regional warehousing.
At least 50% of health systems will offer advanced care at home (e.g. hospital at home).
At least 90% of health systems will expand their capacity to respond to emerging public health challenges
(e.g., opioid crisis, pandemics, multidrug resistant infections).
Health systems will use predictive modeling that integrates data across settings to design optimal
care delivery algorithms.
6
7
8
9
10
13% 33% 44% 11%
30% 55% 12%
3%
7% 39% 38% 16%
22% 48% 27%
3%
27% 50% 21%
3%
Figure 3. (Reimagining Health Systems for Agility and Resilience). Forecast Panelists’ responses to the question,
“How likely is it that the following will occur, by the year 2026, in the geographic region where you work?”.
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PHARMACY FORECAST 2022 AGILITY AND RESILIENCE IN HEALTH SYSTEMS
warehousing (Figure 3, item 7). This
response may indicate that pharmacy
department priorities do not align with
manufacturer and wholesaler prac-
tices, and that distribution practices
must be improved to ensure a stable
supply chain.
AGILITY AND INNOVATION
TO ADDRESS CHANGES IN
HEALTHCARE DELIVERY
The healthcare industry generates
an immense amount of data that can
be leveraged to drive decisions to im-
prove patient care and increase value
in healthcare organizations.7
Clinical
notes, claims data, laboratory results,
prescription use data, genetic data,
medical device data, and imaging
studies are information-rich. Rapidly
evolving wearable device technology
presents a new opportunity to more
effectively manage patients’ chronic
health conditions. Forty-nine percent
of FPs reported that health-system
pharmacists will be managing chronic
conditions from health data gener-
ated remotely (e.g., from wearable or
telehealth applications) in 50% of am-
bulatory patients (Figure 3, item 2).
For the patient, these devices can be
an effective tool to facilitate real-time
monitoring of important clinical data,
including vital signs, activity levels,
and blood glucose measurements.
Pharmacists are well positioned to pro-
vide patient education and support
related to managing wearable devices
and to work with patients to identify
ongoing trends in their data to con-
tribute to improved chronic disease
management. However, pharmacists
must become educated on these de-
vices and provide effective and timely
patient care in response to this data.
Predictive analytics involves use
of large amounts of healthcare data
to enhance preventive measures and
therapies, anticipate and reduce risk,
and optimize healthcare operations
through delivery of personalized pa-
tient care.8
Information gained through
predictive analytics can be used to help
health systems make decisions by an-
ticipating unknown future events or
activities. Seventy-one percent of FPs
indicated that health systems will use
predictive modeling that integrates
data across settings to design optimal
care delivery algorithms (Figure 3,
item 10). Investment in the develop-
ment of health informatics pharma-
cists and predictive modeling tools will
be instrumental as the need for data
analytics, applied to medication use
for prevention and treatment, grows
within healthcare.
AGILE TRANSFORMATION OF
CARE MODELS
Healthcare dramatically changed
over the past year as we faced unpre-
cedented events, and pharmacists
and other healthcare professionals
had to pivot on how and where care
was provided. The FPs echoed the
need for agility in healthcare delivery.
Fifty-five percent of respondents indi-
cated that, in at least 75% of health sys-
tems, interprofessional teams will have
to adopt “pod” structures, or small
multidisciplinary teams who come
together to provide care to patients,
to meet increasing demands placed
on health systems (Figure 3, item 5).
Additionally, 50% of FPs reported that
all health systems will have to offer
advanced care in the home (Figure
3, item 8). Overwhelmingly, FPs sup-
ported the statement that innovations,
such as development of new models of
care and services, will be a perform-
ance expectation of pharmacy leaders
in health systems (Figure 3, item 4).
Examples of such pivoting of care
modelswerenotableduringtheCOVID-
19 pandemic. Pharmacists played roles
in delivering vaccinations to patients’
homes and at drive-thru locations,
apartment complexes, and schools.
No longer was it the expectation that
the patient will come to the delivery
site; now healthcare must be provided
where the patient resides. During the
COVID-19 pandemic, pharmacists and
health systems quickly changed direc-
tion to provide chronic disease state
management remotely, as in-person
visits were too risky. Telehealth visits
using remote videoconferencing were
implemented overnight within health
systems to ensure continuity of care.
The ability to change direction rap-
idly, agility, and the ability to withstand
challenges and recover quickly (i.e.,
resilience) are essential qualities for
health systems and their leaders as they
face pandemics, natural disasters, and
demographic shifts. The insights gained
from FPs’ responses express such sen-
timents as the need to change care de-
livery models, use predictive analytics,
and apply technology to consistently
provide a high level of patient care.
Disclosures
flicts of interest.
References
1. Smollan R. The multi-dimensional na-
ture of resistance to change. J Manage
Organization. 2011;17:828-849.
1. Promote participation of health-
system pharmacists in local,
regional, and national interdis-
ciplinary public health teams.
2. Integrate the use of technology
and data analytics with de-
partmental workforce data to
develop patient care models
that optimize patient health
outcomes.
3. Pharmacists should become
competent in the use of wearable
health metric devices, and use
datafromthesedevicestoimprove
chronic disease management.
4. Invest in development of
new models of patient care
and services with pharmacists as
key providers of health services
using the organization’s data
with predictive analytic tools.
5. Engage in distribution relation-
ships that encourage a stable
pharmacy supply chain.
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2. Federal Emergency Management Agency.
National Disaster Recovery Framework.
Published September 2011. Accessed
July 21, 2021. https://www.fema.gov/pdf/
recoveryframework/ndrf.pdf
3. American Society of Health-System
Pharmacists. ASHP statement on the
role of health-system pharmacists in
emergency preparedness. Am J Health-
Syst Pharm. 2003;60:1993-1995.
4. Goff DA, Ashiru-Oredope D,
Cairns KA, et al. Global contributions
of pharmacists during the COVID-
19 pandemic. J Am Coll Clin Pharm.
2020;3:1480-1492.
5. Dabestani A, DeAngelo D, Chhay SR,
et al. Medication utilization in patients
in New York hospitals during the
COVID-19 pandemic. Am J Health-Syst
Pharm. 2020;77:1885-1892.
6. Haldane V, De Foo C, Abdalla SM, et al.
Health systems resilience in managing
the COVID-19 pandemic: lessons from
28 countries. Nat Med. 2021;27:964-980.
7. Dash S, Shakyawar SK, Sharma M, et al.
Big data in healthcare: management,
analysis and future prospects. J Big
Data. 2019;6(54):1-25.
8. Parikh R, Obermeyer Z, Bates DW.
Making predictive analytics a routine
part of patient care. Harvard Business
Review. Published April 21, 2016.
Accessed August 12, 2021. https://
hbr.org/2016/04/making-predictive-
analytics-a-routine-part-of-patient-
care
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PHARMACY FORECAST 2022 ASSURING WORKFORCE CAPABILITY
Building the Foundation of the Pharmacy Enterprise:
Assuring Workforce Capability
INTRODUCTION
Of all health-system pharmacy
strategy elements, workforce plan-
ning is the most critical. A pharmacy de-
partment could execute well in all other
elements of the pharmacy enterprise, but
if it fails in workforce capacity execution,
the department will stagnate. Often, fac-
tors seemingly unrelated to workforce
planning have significant impact on sour-
cing,recruiting,developing,andretaining
pharmacy technicians and pharmacists.
Projecting future needs for workforce
is difficult in ordinary times; in post-
pandemic America, and combined with
unprecedented upheaval in healthcare, it
becomes a daunting challenge.
Contemporary pharmacy work-
force challenges and opportunities in-
clude (1) the shift to remote work, (2)
projecting workforce supply and de-
mand, (3) expanded scope of practice
of pharmacists and pharmacy tech-
nicians, (4) financial pressures within
health systems, (5) advanced training
requirements for pharmacy staff, (6)
expansion into telehealth, and (7) in-
vestment in innovation/technology.
STAFFING REQUIREMENTS/
REMOTE WORK
Forecast panelists (FPs) were evenly
split (49% to 50%) about the likelihood
of health-system pharmacy depart-
ments developing an industry-wide
standard for productivity metrics to
determine pharmacy staffing require-
ments for patient care services (Figure
4, item 8). Lack of consensus on this
point is not surprising given the pit-
falls of such metrics. Conceptually, a
national benchmark for patient care
service productivity is an inviting con-
cept. However, such benchmarks suffer
from many drawbacks, including prac-
tice model variation, inconsistent
definitions, skill mix decisions made
by health systems, variability in use
of automation and technology, and
failure to properly account for depart-
mental resources.
In 2020, we saw a dramatic shift
to remote work in response to the
COVID-19 pandemic. As employers
ease out of pandemic restrictions, we
face uncertainty about the extent to
which remote work will endure. While
managing a remote workforce presents
both opportunities and challenges,
most FPs (78%) indicated that innova-
tive scheduling and remote work solu-
tions would be necessary to recruit and
retain pharmacists and technicians
in the future (Figure 4, item 6). A tight
post-pandemic labor market will also
put pressure on health systems to offer
employee-friendly schedules and flex-
ible remote work options.
Most FPs (82%) felt that pharma-
cists providing direct patient care
would be likely to interface more fre-
quently with patients remotely rather
than face-to-face (Figure 4, item 2).
However, only 59% of FPs responded
that 30% of the pharmacy workforce
would be likely to work remotely in the
next 5 years (Figure 4, item 7). These re-
sponses seem to point in opposing dir-
ections, with FPs indicating that more
than half of patient care will be pro-
vided remotely but that it is not likely
that the pharmacy workforce will work
from remote locations. Perhaps pa-
tients will be more comfortable with
remote patient care than health sys-
tems will be with pharmacy employees
working remotely. Pharmacy roles that
have been successfully transitioned
to remote work likely will continue to
be performed remotely. For example,
positions outside acute care, like re-
gional and system leadership roles,
ambulatory care positions, managed
care positions, and specialty phar-
macy positions, will likely continue to
be remote.
The expansion of telework has op-
portunities as well as challenges—it
can increase efficiencies at work (fewer
interruptions), but it also can result in
increased work (more emails due to
less face time to problem solve, create,
and innovate in person). Likewise,
while remote work can increase prod-
uctivity by increasing the capacity to
connect across groups, it can also result
in lack of meaningful connections with
people, lack of team bonding/building,
and feelings of isolation, all of which
can contribute to burnout. Strategies
for dealing with burnout or fatigue from
the transition of traditional roles to re-
mote work should be implemented.
ADVANCED TRAINING/
CONTINUOUS
PROFESSIONAL
DEVELOPMENT
Most FPs (79%) responded that ex-
panding the role of pharmacy techni-
cians would pave the way for additional
patient care support services (Figure 4,
item 3). This observation is consistent
with the 2021 Pharmacy Forecast, in
which 78% of FPs predicted that it is
very or somewhat likely that techni-
cians will have advanced roles in at
least 75% of health systems.1
During
the COVID-19 pandemic, the rates of
worker departures and retirements in-
creased due to job losses, business clos-
ures, and concerns for personal safety,
with older workers retiring earlier than
Tom Woller, M.S., RPh, FASHP,
President, TWWRX, LLC, Fort Myers, FL,
USA
Elva Angelique Van Devender, Ph.D.,
Pharm.D., BCPS, DPLA, Regional
Program Manager, Clinical Pharmacy
Education, Providence Health & Services,
Oregon Region, Portland, OR, USA
Address correspondence to Mr. Woller
(tomwoller@hotmail.com).
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ASSURING WORKFORCE CAPABILITY PHARMACY FORECAST 2022
Figure 4. (Building Workforce Capability). Forecast Panelists’ responses to the question, “How likely is it that the fol-
lowing will occur, by the year 2026, in the geographic region where you work?”.
Pharmacists in 50% of health systems will participate in the design and implementation
of remote care technology in the provision of patient care.
Pharmacists providing direct patient care will interface more frequently with patients via remote technology
applications than face-to-face with patients.
In at least 75% of health systems, pharmacy technicians with advanced training will provide patient care
support services (e.g., by conducting medication reconciliation, taking medication histories, extracting data
from health records).
25% of routine pharmacy tasks linked to technology will be replaced by digital health solutions
or artificial intelligence.
1
2
3
4
5
50% of health systems will require pharmacy leaders to complete formal leadership development programs.
%
3
2
%
9
4
%
6
2
3%
%
0
4
%
2
4
%
4
1
%
4
2% %
5
3
%
4
4
%
9
1
%
6
1
%
0
4
%
6
3
%
8
%
9
%
7
4
%
8
3
%
6
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Innovative scheduling and remote work solutions will be required to recruit and retain pharmacists
and pharmacy technicians.
30% of the health-system pharmacy workforce will work remotely.
Health-system pharmacies will develop an industry-wide standard for productivity metrics used to determine
pharmacy staffing requirements for delivery of patient care services.
Health systems will expand paid and unpaid leave time to promote continuous professional development.
Health systems will invest in innovation training to support a more agile workforce.
6
7
8
9
10
%
9
%
0
4
%
7
3
%
3
1
%
1
3
%
7
4
%
8
1
%
4
%
5
1
%
4
4
%
4
3
%
8
%
3
%
9
2
%
8
4
%
0
2
%
9
%
6
4
%
7
3
%
7
Figure 4. (Building Workforce Capability). Forecast Panelists’ responses to the question, “How likely is it that the fol-
lowing will occur, by the year 2026, in the geographic region where you work?”.
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ASSURING WORKFORCE CAPABILITY PHARMACY FORECAST 2022
expected.2
Post-pandemic trends point
to a surge in retirements, as workers
whodelayedretirementduetothecrisis
are now able to do so.3
In addition, up-
ward pressure on entry-level wages and
demand in retail and manufacturing
will make recruitment and retention
of pharmacy technicians much more
difficult. Health systems must focus on
development of infrastructure that sup-
ports long-term sustainability of phar-
macy technician roles. As the scope of
pharmacists’ practice continues to in-
crease, new opportunities for advanced
technician roles and leadership will
emerge. Given the likelihood of con-
tinued diminishing resources within
health systems and the necessity of
“doing more with less,” the develop-
ment of defined career paths for techni-
ciansthatincludestandardizedtraining
programs, national certification, and
mandatory licensure is needed in the
next 5 years to improve care and reduce
costs. Health-system pharmacy leaders
should consider partnering with col-
leagues in human resources, talent ac-
quisition, and compensation to expand
technician roles.
FPs were split (56% to 44%) on the
likelihood of health systems requiring
pharmacy leaders to complete leader-
ship development programs (Figure
4, item 4). Most FPs (68%) reported it
was unlikely that health systems would
be willing to expand paid and unpaid
leave time to promote continuous pro-
fessional development for staff (Figure
4, item 9). Given the expansion of the
role of pharmacists and technicians in
patient care, the investment in the pro-
fessional development of staff should
be prioritized by health-system leaders
and implemented to build a founda-
tion for a successful and engaged pa-
tient care team. Sustainable systems of
shared accountability by employees and
administration for knowledge and skill
development should be considered as
a means of investing in human capital.
INNOVATION AND
TECHNOLOGY
Most FPs (72%) reported that phar-
macists in health systems would likely
participate in the design and implemen-
tation of remote patient care technology
(Figure 4, item 1). This is consistent with
the 2021 Pharmacy Forecast, wherein
morethan90%ofFPsagreedthatsignifi-
cant expansion of pharmacist telehealth
services will improve patient outcomes
in rural and other underserved locations
in the next 5 years.1
Telehealth uptake
grew dramatically in the early phases
of the COVID-19 pandemic but it is un-
clear whether patient acceptance of
telehealth will continue. In the wake of
the COVID-19 pandemic, we may con-
tinue to see considerable growth and
pharmacist involvement in telehealth,
particularly in the areas of medication
therapy monitoring, transitions of care,
and patient consultations. If this occurs,
therewillbeadefinitiveimpactonwork-
force planning and skill development.
Although telehealth is more com-
monly used due to increased availability,
accessibility, convenience, and cost-
effectiveness,FPsweresplit(56%to44%)
on the likelihood that routine pharmacy
tasks linked to technology would be re-
placed by digital health solutions or
artificial intelligence (Figure 4, item 5).
Additionally, FPs were also split (55% to
44%) on the likelihood that health sys-
tems will invest in innovation to sup-
port a more agile workforce (Figure 4,
item 10). This schism among the FPs
points to increasing comfort with tech-
nology among some health systems
but also shows a fair amount of skep-
ticism about the value of technology in
replacing traditional pharmacy tasks.
Prudent pharmacy leaders will en-
gage C-suite leaders, as well as those
in human resources, information tech-
nology, and operations, to assure that
pharmacy has a seat at the table during
remote care technology planning and
development.
1. Actively partner with col-
leagues in human resources
to identify and prioritize op-
portunities for innovative
scheduling and remote work
solutions to assist with recruit-
ment and retention of pharma-
cists and technicians across the
pharmacy enterprise.
2. Engage with human resources
leaders to develop a sustain-
able career advancement model
for pharmacy technicians. This
should include perpetual devel-
opment of advanced pharmacy
technician roles and strategies
to attract and retain pharmacy
technicians.
3. Actively plan and schedule time
for pharmacy staff to pursue
continuing education and pro-
fessional development activities
(e.g., precepting, leadership,
and research) to foster career
growth, career development,
and a culture of learning.
4. Develop a comprehensive plan
by which pharmacists can par-
ticipate in the design and im-
plementation of remote patient
care technology to promote op-
timal patient outcomes. Engage
the C-suite to ensure that phar-
macy is actively involved in or-
ganizational plans for remote
patient care implementation.
5. Institute a rolling 7-year tech-
nology investment plan that
addresses projected contem-
porary, post-pandemic health-
system pharmacy needs. Engage
C-suite leaders in the develop-
ment and execution of the plan.
6. Establish strategies and re-
sources for employee resilience
and well-being specifically tar-
geted on mitigation of burnout
andfeelingsofisolationforphar-
macists and pharmacy techni-
cians who are transitioning from
traditional in-person work to
more permanent remote work.
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Disclosures
flicts of interest.
References
1. Di Piro JT, Fox ER, Kesselheim ES, et al.
ASHP Foundation pharmacy forecast
2021: strategic planning advice for
pharmacy departments in hospitals
and health systems. Am J Health-Syst
Pharm. 2021;78:472-479.
2. Kolko J. The upshot: in reversal, retire-
ments increased during the pandemic.
New York Times. Published May 12,
2021. Accessed June 24, 2021. https://
www.nytimes.com/2021/05/12/upshot/
retirements-increased-pandemic.html
3. Fry R. The pace of Boomer
retirements has accelerated in
the past year. Pew Research Center.
Published November 9, 2020.
Accessed June 25, 2021. https://www.
pewresearch.org/fact-tank/2020/
11/09/the-pace-of-boomer-
retirements-has-accelerated-in-the-
past-year
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PHARMACY PREPAREDNESS FOR CHANGE PHARMACY FORECAST 2022
Pharmacy Preparedness For Change
INTRODUCTION
The COVID-19 pandemic under-
scored the importance of prepared-
ness. The intent of this Forecast chapter
is to describe Forecast Panelists’ (FPs)
assessment of pharmacy preparedness
with respect to designated statements,
whereas previous Forecast chapters fo-
cused on the likelihood of these state-
ments. Overall, responses were similar
for likelihood and preparedness; how-
ever, differences of at least 10% were
seen in market growth, social health
determinant screening, chronic condi-
tions management via technologically
enabled applications, and advanced
data analytics to address healthcare
disparities.
BUSINESS AND SERVICE
LINE GROWTH
Seventy-seven percent of FPs re-
ported that they are very or somewhat
prepared to add new service lines
or business ventures (Figure 5, item
1) that increase market share and rev-
enue, whereas 92% (Figure 1, item
1) indicated that this growth was likely
in the next 5 years. With the dynamic
healthcare payer landscape, shift to
lower cost sites of care, and increases
in the number of specialty pharma-
ceuticals, growth opportunities exist
in alternate sites of care for infusion
therapies, hospital at home programs,
and specialty pharmacy. For self-
insured health systems, pharmacy’s
engagement in employee prescrip-
tion benefit management and medi-
cation wellness clinics supports the
bottom line and optimizes medica-
tion management. Opportunities also
exist to partner with payers and em-
ployers in the management of high-risk
populations.
PHARMACISTS AS
PROVIDERS
The benefits of pharmacist pro-
vider status are recognition and reim-
bursement. Sixty-four percent of FPs
believed that they are prepared for pro-
vider status (Figure 5, item 2), trending
consistently with the 66% of FPs (Figure
2, item 10) who believe this is likely to
occur by 2026. Given the prevalence of
chronic diseases in the United States
(6 in 10 Americans have 1 or more
chronic diseases) coupled with an
aging population, recognizing pharma-
cists as providers would support com-
prehensive medication management
and improve outcomes for vulnerable
patients.1
Perhaps the hesitancy of
some FPs regarding preparedness for
provider status is attributable to a lack
of confidence that reimbursement will
be provided under value-based reim-
bursement models, the limited capacity
to fund additional pharmacy services if
reimbursement is nominal, and/or in-
adequate clinical preparedness for ex-
panded services.
ADVANCING PHARMACY
TECHNICIANS’ ROLES
Compared to the 2019 ASHP
Pharmacy Forecast, a significantly
greater proportion of FPs (73%) be-
lieved they are prepared to expand
technician roles to patient care activ-
ities (Figure 5, item 3).2
These results are
likely attributed to the growing number
of technicians serving as pharmacist
extenders to support transitions of care,
clinical monitoring, and data analytics.
Beyond medication reconciliation,
patient-facing technician roles include
postdischarge follow-up and specialty
pharmacy call center activities (e.g.,
assessing adherence, monitoring ad-
verse events, and triaging patient ques-
tions), prior authorization for high-cost
medications, and patient assistance
programs to ensure medication ac-
cess.3,4
To adequately train technicians
for advanced roles, innovative training
curricula, such as a technician resi-
dency, advanced certification, and
continuing professional development
programs, should be considered to
meet this need.5
SOCIAL DETERMINANTS OF
HEALTH AND DISPARITIES
Less than 50% of FPs responded that
pharmacists and pharmacy technicians
are very or somewhat unprepared to
systematically screen patients for social
determinants of health (SDOH) and
use advanced data analytics to address
healthcare disparities (38% [Figure 5,
item 4] and 48% [Figure 5, item 7] of
respondents, respectively), while 51%
of respondents (Figure 2, item 1) and
73% of respondents (Figure 2, item 3),
respectively, felt that pharmacist and
pharmacy technician involvement in
those activities was likely to occur.
Healthcare systems can improve
preparedness through recognition of
healthcare disparities and addressing
such disparities by providing pharmacy
staff with opportunities to train and
screen for SDOH. Developing resources
inallhealthsystemstotrainpharmacists
and technicians on screening for SDOH
and exploring the most impactful deter-
minants of health disparities are crucial
in being prepared for this role.
Mandatory quarantines during
the COVID-19 pandemic changed
the way we work and interact with
each other. As the country increas-
ingly addresses the digital divide at
all levels, including in healthcare,
Rita Shane, Pharm.D., FASHP,
FCSHP, Vice President and Chief
Pharmacy Officer, Department of
Pharmacy Services, Professor of
Medicine, Cedars-Sinai Medical Center,
Los Angeles, CA, and Professor of
Medicine and Associate Dean, Clinical
Pharmacy, UCSF School of Pharmacy,
Los Angeles, CA, USA
Francesca Cunningham, Pharm.D.,
Director, Center for Medication Safety,
Department of Veterans Affairs, Hines,
IL, USA
Address correspondence to Dr. Shane
(Rita.Shane@cshs.org).
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PHARMACY FORECAST 2022 PHARMACY PREPAREDNESS FOR CHANGE
pharmacists should be prepared to
ensure that all patients have the cap-
ability to interact with their pharma-
cists from the comfort of their home.
This remote interaction should in-
clude the ability to upload pertinent
health data for medication man-
agement. Moreover, health systems
should be prepared to leverage ad-
vanced analytics to address and
manage all patients, including those
with healthcare disparities.
Figure 5. (Pharmacy Preparedness). Forecast Panelists’ responses to the question, “If the following occurs by the year
2026, how prepared is your health system, pharmacy department or staff to respond?”.
If the following occurs by the year 2026,
,
m
e
t
s
y
s
h
t
l
a
e
h
r
u
o
y
s
i
d
e
r
a
p
e
r
p
w
o
h
pharmacy department or staff?
Very Somewhat Somewhat Very
d
e
r
a
p
e
r
P
d
e
r
a
p
e
r
P
d
e
r
a
p
e
r
p
n
U
d
e
r
a
p
e
r
p
n
U
Pharmacy leaders adding new service lines
or business ventures that increase market 1% 21% 55% 22%
share and revenue.
Pharmacists as designated healthcare
providers by the Centers for Medicare and 7% 25% 48% 20%
Medicaid Services.
Pharmacy technicians with advanced
training providing patient care support services 4% 23% 50% 23%
(e.g., by conducting medication reconciliation,
taking medication histories, extracting data
from health records).
Pharmacists and pharmacy technicians
systematically screening patients for social 18% 44% 32% 6%
determinants of health.
Pharmacists managing chronic conditions
from health data generated remotely (e.g., 9% 27% 48% 16%
from wearable or telehealth applications).
Health system utilizing digital health solutions
and artificial intelligence technology to improve 11% 38% 42% 9%
medication management.
Health system using advanced data analytics
to address healthcare disparities (e.g.,
population cultural preferences, digital 12% 40% 42% 6%
divide, prevention measures).
Health system having the capacity to respond
to emerging public health challenges (e.g., 3% 15% 64% 18%
opioid crisis, pandemics, multidrug resistant
infections).
1
2
3
4
5
6
7
8
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Figure 6. (Pharmacy Preparedness—Identifying Gaps). Identifying potential gaps in practice by comparing the re-
sponses to selected questions for likeliness to occur and preparedness of health systems, pharmacy departments or staff
to respond by the year 2026.
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PHARMACY FORECAST 2022 PHARMACY PREPAREDNESS FOR CHANGE
MEDICATION MANAGEMENT
WITH REMOTE HEALTH
DATA AND DIGITAL HEALTH
SOLUTIONS
With the COVID-19 pandemic ac-
celerating the utilization of telehealth
to meet the needs of patients, it is not
surprising that over half of FPs (64%) re-
ported that pharmacists are prepared to
manage chronic conditions from health
data generated remotely (Figure 5, item
5). There was an almost even split in re-
sponses with regard to both likelihood
and preparedness of health systems to
utilize digital health solutions and artifi-
cialintelligence(AI)formedicationman-
agement optimization (Figure 5, item 6).
These responses underscore the poten-
tial for beneficial gains and unintended
consequences of technology, requiring
additional work to streamline any digital
health solutions into current workflows.
Telehealth clinics, digital solutions,
and AI in healthcare have expanded in
recent years, and this trend will likely
be accelerated over the next 5 years
as a result of the pandemic, requiring
health systems to adopt new methods
or optimize current methods to en-
hance telehealth and obtain health data
using remote tools and applications.
Healthcare systems should be prepared
to educate patients on utilizing tech-
nology to ensure optimal medication
management.
Large database analytics will in-
creasingly be used as a population
health strategy. These databases will
facilitate monitoring and evaluation
of the impact of comprehensive medi-
cation management through standard
metrics and dashboards that delineate
utilization, adherence, persistence, and
clinical outcome indicators. Health
systems should be prepared to use not
only traditional structured data from
patients (i.e., clinical laboratory data,
prescription data, diagnosis data) but
also unstructured data (i.e., provider
notes, imaging test results translated
through AI and imported into appli-
cations/tools) that can be used for en-
hanced medication management.
NAVIGATING CRISIS CARE
TheCOVID-19pandemichighlighted
the “will and skills” of pharmacy profes-
sionals when confronted with a crisis;
accordingly, 82% of FPs indicated that
health systems are prepared to respond
to emerging public health challenges
(Figure 5, item 8). During the pandemic,
pharmacy staff demonstrated core be-
havioral attributes such as “teamness,”
nimbleness, and flexibility. Leadership,
ownership, just-in-time decision-
making, and adapting to ever-changing
patient care needs while managing per-
sonal health risks characterize the re-
siliency referenced in the 2020 ASHP
Pharmacy Forecast.6
The critical need
to support sterile compounding, supply
chain management, and investigational
drug services during the pandemic re-
vealed important education gaps and
opportunities for the profession.
Acknowledgments
The authors recognize and thank Thanh Tu,
PharmD, for assistance in the preparation of
this work.
Disclosures
flicts of interest.
References
1. Centers for Disease Control and
Prevention. National Center for
Chronic Disease Prevention and Health
Promotion home page. Accessed
June 25, 2021. https://www.cdc.gov/
chronicdisease/index.htm
2. Vermeulen LC, Eddington, ND, et al.
ASHP Foundation pharmacy forecast
2019: strategic planning advice for
pharmacy departments in hospitals
and health systems. Am J Health-Syst
Pharm. 2019;76(2):71-100.
3. Traynor K. Specialty pharmacy
technicians assume advanced roles.
1. Pharmacy leaders should dem-
onstrate financial stewardship
by monitoring the evolving payer
landscape; exploring growth op-
portunities in areas such as spe-
cialty pharmacy, alternative sites
of care, and employee prescrip-
tion benefits; and implementing
strategies to prevent high-cost
drug denials.
2. To support departmental and
organizational goals, pharmacy
leaders should develop and
continuously refine the training
curriculum for pharmacy tech-
nicians to prepare this work-
force for advanced roles in
patient-focused activities and
data analytics.
3. Standardized SDOH protocols
should be developed, auto-
mated, and integrated into daily
workflow for screening of every
patient, and healthcare systems
should develop or adopt ana-
lytic programs for pharmacists
to assess/screen for SDOH to
enhance medication manage-
ment for those with chronic
diseases.
4. Pharmacists should develop
educational programs and other
training tools to better pre-
pare themselves and pharmacy
technicians to use telehealth
medication management as the
primary method of interacting
with patients.
5. Health systems should de-
velop or optimize digital solu-
tions, including dashboards, for
enhancing medication manage-
ment, as well as AI tools, to in-
tegrate unstructured data into
decision-making tools in an
automated fashion.
6. Preparedness for public health
challenges should be integrated
into ongoing strategic plan-
ning and staff training. Core
behavioral skills and know-
ledge of pharmacy operations
represent essential elements of
preparedness.
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News. Am J Health Syst Pharm.
2020;77(6):413-414.
4. Pevnick JM, Nguyen C, Jackevicius CA,
et al. Improving admission medication
reconciliation with pharmacists or
pharmacy technicians in the emer-
gency department: a randomized
controlled trial. BMJ Qual Saf.
2018;27(7):512-520.
5. Youmbi KV, Shane R. Implementation
of a pharmacy technician residency
program in a tertiary care teaching
hospital. Am J Health-Syst Pharm.
2019;76(8):543-550.
6. Vermeulen LC, Swarthout MD,
Alexander GC, et al. ASHP Foundation
Pharmacy Forecast 2020: strategic
planning advice for pharmacy de-
partments in hospitals and health
systems. Am J Health-Syst Pharm.
2020;77(2):84-112.
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