NURSING

1. Field Experience in Nursing
Management and
Administration
Dr. Bella P. Magnaye

2. Competencies Needed:
•Communication and Building Relationships
•Knowledge of the Healthcare Environment
•Leadership
•Collaboration
•Organizational Business Administration

3. Healthcare Task Forces
• Public and patients
• International influences on health and healthcare
• Older people
• Organization and delivery of healthcare
• Information
• Delivering the promise of the human genome
• Pharmaceuticals, biotechnology and medical devices
• Neuropsychiatric health
• Transplantation

4. Moving Forward
• Commit to a national statement of purpose for the health care system
• Six aims
• safety, avoid injuries
• effective, evidence based
• patient centred, patient values guide decisions
• timely, reduce waiting and delay
• efficient, avoid waste
• equitable, care doesn’t vary by gender, ethnicity, etc

5. 10 Rules for Redesigning Health Care
• 1. Care based on continuous healing relationships--care
whenever its needed, not just through face to face visits
• 2. Customization based on patient needs and values
• 3. The patient as the source of control
• 4. Shared knowledge and free flow of information

6. 10 Rules for Redesigning HealthCare
• 5.Evidence based decision making
• 6. Safety as a system property
• 7. The need for transparency--all information available, including
the system’s performance on safety, evidence based practice, and
patient satisfaction
• 8. Anticipation of needs
• 9. Continuous decrease in waste
• 10. Cooperation among clinicians

7. Getting Started
• Concentrate on the conditions that account for most health care
(cancer, heart disease, mental health)
• Produce plans that will lead to substantial improvements--like
England’s national service frameworks
• A fund for innovation

8. Six Challenges for Health Care Organizations
• 1. Design seamless, coordinated care
• 2. Make effective use of IT, including automating patient records
• 3. Manage knowledge so that it is delivered into patient care

9. Six Challenges for Health Care Organizations
• 4. Coordinate care across patient conditions,
services, and settings over time
• 5. Advance the effectiveness of teams
• 6. Incorporate measurement of care processes and
outcomes into daily practice

10. What will survive as the world changes
completely:
• 1. Clear ethical values
• 2. Being clear about our mission
• 3. Putting patients first
• 4. Constantly trying to improve
• 5. Basing what we do on evidence
• 6. Leadership
• 7. Learning

11. Top 10 Trends Countdown 11
1
2
3
4
5
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7
8
9
10 Health care everywhere

12. • The Location of Care is Shifting Beyond Health Care Facilities
• Non-Physician Care Roles are Expanding
• Innovations in Technology are Fueling Enhanced Patient
Engagement
• A New Generation of Health Care Roles Will Emerge
• New Care Settings Bring New Challenges in Coordination
Health Care Everywhere
12
10

13. Health Care Everywhere
CHANGING THE PLACE
OF CARE
REDEFINING PATIENT
OUTREACH
MEDICALIZATION OF
CONSUMER DEVICES
13
10

14. Looking Ahead:
Health Care Everywhere
• Expanded role for retail pharmacies
• Technologies and devices to enable physician extenders
• New roles in the health care workforce
Opportunities Ahead
Challenges Ahead
• Care coordination and continuity of care
• Data portability and technology integration
For Educators
• Focusing on coordination-of-care training
• Expansion of pharmacy practice areas: patient care and outreach
• Offering experiential training in innovative settings
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10

15. Top 10 Trends Countdown 15
1
2
3
4
5
6
7
8
9 Increasing patient cost sharing
10 Health care everywhere

16. Increasing Patient Cost Sharing
• Patient Cost Sharing is Increasing
• New Provider Payment Models May
Increase Patient Financial Risk
• Non-financial Approaches are Needed to
Effectively Engage Patients
16
9

17. Current Trends:
Increasing Patient Cost Sharing
COST SHARING FOR
PHARMACEUTICALS IS RISING
PATIENT ENGAGEMENT
IS IMPORTANT
BENEFIT DESIGNS ARE
INCREASING
PATIENT FINANCIAL RISK
IMPACT OF COST SHARING ON
CARE SEEKING BEHAVIORS
17
1. Magellan Pharmacy Solutions 2012; 2. CVS Caremark 2013; 3. PwC Health Research Institute 2013b; 4.
Blumenthal 2013;
9

18. Looking Ahead:
Increasing Patient Cost Sharing
• Promoting the use of high value services
• Increasing patient ownership over disease management
Opportunities Ahead
Challenges Ahead
• Balanced risk sharing models are needed
• Changes in provider payment and health system delivery
For Educators
• Raise awareness that greater patient cost sharing has the potential
to limit adherence with therapies, without appropriate balances
• Understand that methods to optimize patient decision making will
require novel consumer-focused technologies
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9

19. Top 10 Trends Countdown 19
1
2
3
4
5
6
7
8 Role of technology in patient engagement
9 Increasing patient cost sharing
10 Health care everywhere

20. Role of Technology
in Patient Engagement
• The Rise of Health Care Technologies is Empowering Patients
• Technology Tools Support Communication and Decision-Making
• Patients are Becoming “Consumers”
• Patient Education and Technology Coordination are Keys to Success
• The “Digital Divide” is a Risk for Some
20
8
8

21. Current Trends: Role of Technology
in Patient Engagement
PATIENTS WILL DRIVE
TECHNOLOGY USE
TECHNOLOGY IN DISEASE
MANAGEMENT
TECHNOLOGY IN
MEDICATION
MANAGEMENT
DEMOGRAPHICS
IMPACT USAGE
21
8
8

22. Looking Ahead:
Role of Technology in Patient Engagement
• Improved patient health care decision-making
• Patient ownership over disease management
Opportunities Ahead
Challenges Ahead
• Patient education including health literacy and e-literacy
• Coordination of technologies
• The digital divide
For Educators
• Technology will play several roles in connecting to patients
regarding their pharmaceutical care and cost sharing
22
8
8

23. Top 10 Trends Countdown 23
1
2
3
4
5
6
7 Growth and performance of accountable care organizations
8 Role of technology in patient engagement
9 Increasing patient cost sharing
10 Health care everywhere

24. Growth and Performance of ACOs
24
7
8
7
• ACOs are Expanding
• Early Data on ACOs are Promising
• ACO-Type Thinking is a Necessary Transitional
Step
• Data and Analytics Will be Key for ACOs
• A Broader Culture Shift is Needed to Bend the
Cost Curve

25. Current Trends:
Growth and Performance of ACOs
PUBLIC & PRIVATE ACOS ARE
ON THE RISE
APPEAL OF THE ACO MODEL
PIONEER ACOS 
MIXED RESULTS
25
1. Muhlestein 2013a; 2. Gold 2014; 3. Ignagni 2013; 4. Sanofi 2013; 5. Petersen 2013; 6. Muhlestein 2013b; 7.
CMS 2013; 8. Gold 2014
7
8
7

26. Looking Ahead:
Growth and Performance of ACOs
• Dual focus on cost and quality
• Data-driven insights
For Educators
Challenges Ahead
Opportunities Ahead
• Reduced provider autonomy
• Sharing revenue
• Fragmented health system
• ACO and shared-savings models offer opportunities for pharmacy
• Shared savings through better adherence and persistence?
• University-based health systems and ACOs: an opportunity for
student experience?
26
7
8
7

27. Top 10 Trends Countdown 27
1
2
3
4
5
6 Migration to value-oriented health care marketplace
7 Growth and performance of accountable care organizations
8 Role of technology in patient engagement
9 Increasing patient cost sharing
10 Health care everywhere

28. Migration to Value-Oriented
Health Care Marketplace
• Migration to Value-Oriented Marketplace is Occurring
• Defining “Value” Will be Necessary
• Meaningful, Measurable Patient Outcomes Must be Defined and
Tracked
• Multi-faceted Approaches Will be Needed
28
6
7
8
6

29. Current Trends: Migration to Value-Oriented
Health Care Marketplace
DRIVING VALUE
THROUGH INCENTIVES
CHALLENGES IN
PAYING FOR VALUE
29
FINANCIAL INCENTIVES
ALONE MAY NOT DRIVE
VALUE
6
7
8
6

30. Looking Ahead: Migration to Value-Oriented
Health Care Marketplace
• Era of value-based marketplace
• Paying for value instead of services
Opportunities Ahead
Challenges Ahead
• Lack of consistent definition of “value”
• Lack of available data
For Educators
• Ensure pharmacy students grasp the concept of value in health care
treatment (from both the patient’s and system’s perspective)
• Champion a dialogue on standard benchmarks for value
• Establish procedures to iteratively evolve the definition of value
30
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31. Top 10 Trends Countdown 31
1
2
3
4
5 Medicaid expansion due to health care reform
6 Migration to value-oriented health care marketplace
7 Growth and performance of accountable care organizations
8 Role of technology in patient engagement
9 Increasing patient cost sharing
10 Health care everywhere

32. Medicaid Expansion
due to Health Care Reform
• Medicaid Enrollment is Increasing
• States Hold the Power to Drive Expansion
• Cost Reduction and Care Efficiency Will be Key
• Medicaid Expansion Will be a Hot Bed of Innovation for Change
• Improved Outcomes With Lower Reimbursements Will be Necessary
32
5
6
7
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5

33. Current Trends: Medicaid Expansion
due to Health Care Reform
MEDICAID ENROLLMENT WILL
RISE
STATE RESPONSES WILL
VARY
MEDICAID EXPENDITURES
WILL RISE
EXPANSION WILL HARNESS
NEW CARE DELIVERY MODELS
33
1. Sanofi 2013; 2. Cannon 2012; 3. KFF 2014; 4. The Advisory Board Company 2014; 5. Rudowitz 2014; 6. Kocot
2013
5

34. Looking Ahead: Medicaid Expansion
due to Health Care Reform
• A “hot bed” of innovation
• New roles
For Educators
Challenges Ahead
Opportunities Ahead
• Potential trickle-down effect of financial risk
• Difficult processes for treating and paying for the uninsured
• Greater opportunities for pharmacy to play new roles in primary
care and on the care team
• More need than ever for pharmacy students to deeply understand
the evolving health system and grasp new innovations and their
effect on traditional provider roles
34
5

35. Top 10 Trends Countdown 35
1
2
3
4 Spending and utilization for specialty pharmaceuticals
5 Medicaid expansion due to health care reform
6 Migration to value-oriented health care marketplace
7 Growth and performance of accountable care organizations
8 Role of technology in patient engagement
9 Increasing patient cost sharing
10 Health care everywhere

36. Spending and Utilization
for Specialty Pharmaceuticals
• Specialty Medicine Spending and Utilization Will Continue to Grow
• Biosimilars Have the Potential to Shift the Cost Curve
• Scientific Advances Can Help Get the Right Treatments to the Right
Patients
• Promoting Optimal Use of Specialty Medications Requires New
Approaches
36
4

37. Current Trends: Spending and Utilization
for Specialty Pharmaceuticals
SPECIALTY BOOM
WILL CONTINUE
BIOSIMILARS BRING
MARKET OPPORTUNITY
HEALTH PLAN
RESPONSES TO
SPECIALTY SPENDING
RISE
37
4

38. Looking Ahead: Spending and Utilization
for Specialty Pharmaceuticals
38
4
• “Personalized” or “precision” medicine
• Improved patient outcomes
Opportunities Ahead
• Final regulatory framework for biosimilars
• Over-specialization of care
• Prepare new pharmacists with focused education on specialty and biosimilars, including the
challenges for bioequivalence, safety, and efficacy
• Differentiate the nuances of the pharmacy vs. medical benefit in pharmacy practice in
teaching/experiential learning
Challenges Ahead
For Educators

39. Top 10 Trends Countdown 39
1
2
3 Widespread use of data and analytics in patient care
4 Spending and utilization for specialty pharmaceuticals
5 Medicaid expansion due to health care reform
6 Migration to value-oriented health care marketplace
7 Growth and performance of accountable care organizations
8 Role of technology in patient engagement
9 Increasing patient cost sharing
10 Health care everywhere

40. Widespread Use of Data
and Analytics in Patient Care
• Patient Data Assets are Multiplying
• Data and Analytics-Based Insights Will Drive Care Efficiency
• Collecting the “Right Data” is Increasingly Important
• Integrated Systems are Primed to Lead the Way
• Organizational and Operational Barriers Must be Addressed
40
3

41. Current Trends: Widespread Use of Data and
Analytics in Patient Care
EXPANDED USE OF
ELECTRONIC
HEALTH RECORDS
MULTIPLE SOURCES OF
DATA WILL ARISE
LACK OF RELEVANT AND
MEASURABLE PATIENT
OUTCOMES PRESENT BARRIERS
NEW DATASETS WITH NEW
PURPOSES
41
3

42. Looking Ahead: Widespread Use of Data
and Analytics in Patient Care
• Data driven insights
• Transparency in the care provision process
For Educators
Challenges Ahead
Opportunities Ahead
• Fragmented patient data
• Reluctance of many clinicians
• Availability of meaningful patient metrics
• Introduce to students the concepts of EHR and HIT in general, and the contributions/roles of
pharmacy in collecting data
• Discuss with pharmacy students the benefits and challenges in using analytics to track patient
care
42
3

43. Top 10 Trends Countdown 43
1
2 Consolidation of health care stakeholders
3 Widespread use of data and analytics in patient care
4 Spending and utilization for specialty pharmaceuticals
5 Medicaid expansion due to health care reform
6 Migration to value-oriented health care marketplace
7 Growth and performance of accountable care organizations
8 Role of technology in patient engagement
9 Increasing patient cost sharing
10 Health care everywhere

44. Consolidation of Health Care Stakeholders
• Consolidation of Health Care Stakeholders is on the Rise
• Decision-Making Will Become Centralized and Standardized
• The Balance of Market Power Will Shift
• Consolidation Creates New Opportunities in Health Information
Technology
44
2

45. Current Trends:
Consolidation of Health Care Stakeholders
HOSPITAL MERGERS ON THE
RISE
INCREASED HORIZONTAL
INTEGRATION
REACTIVE CONSOLIDATION COORDINATED
DECISION-MAKING
45
1. Enders 2014; 2. Brooks 2012; 3. Genentech 2012; 4. Hernandez 2013
2

46. Looking Ahead: Consolidation of
Health Care Stakeholders
46
2
• Increased use of data and technology
• Increased care efficiency
• More negotiating power
Opportunities Ahead
• Gaps in data on longitudinal patient outcomes and the health care
supply chain
• Shifts in the conventional provider role
• Ensure pharmacy students are prepared to work in an environment characterized by
changing payment models and IDNs and can critically analyze the pharmaceutical
purchasing/supply chain
For Educators
Challenges Ahead

47. Top 10 Trends Countdown 47
1 Migration from fee-for-service to new provider payment models
2 Consolidation of health care stakeholders
3 Widespread use of data and analytics in patient care
4 Spending and utilization for specialty pharmaceuticals
5 Medicaid expansion due to health care reform
6 Migration to value-oriented health care marketplace
7 Growth and performance of accountable care organizations
8 Role of technology in patient engagement
9 Increasing patient cost sharing
10 Health care everywhere

48. Migration from FFS to
New Provider Payment Models
• Focus on Paying for Accountability
• Stakeholders are Employing a Variety of New Models
• Payers Hold the Responsibility for Designing Balanced Models
• Payment Changes are Shifting Care Delivery Practices
48
1

49. Current Trends: Migration from FFS to
New Provider Payment Models
BUNDLED PAYMENTS IN
ONCOLOGY
BUNDLED PAYMENTS IN
HOSPITALS
BUNDLED PAYMENTS ARE
SUCCESSFUL
COLLABORATION IS KEY IN
DESIGNING NEW MODELS
49
1

50. Looking Ahead: Migration from FFS to New
Provider Payment Models
• High-quality patient outcomes
• Reduced costs for government and commercial
• New approaches for care delivery
For Educators
Challenges Ahead
Opportunities Ahead
• Lack of long-term data on performance
• Potential abandonment/reduction of care for certain high-cost
chronic diseases
• Ability of providers to identify and reduce waste
• Payment reform will need to be an evolving process
• Illustrate opportunities for pharmacists to provide value in such
systems
50
1

51. Top Ten Emerging Health Care Trends
51
1 Migration from fee-for-service to new provider payment models
2 Consolidation of health care stakeholders
3 Widespread use of data and analytics in patient care
4 Spending and utilization for specialty pharmaceuticals
5 Medicaid expansion due to health care reform
6 Migration to value-oriented health care marketplace
7 Growth and performance of accountable care organizations
8 Role of technology in patient engagement
9 Increasing patient cost sharing
10 Health care everywhere

52. Implications For Pharmacy Educators
• The role of pharmacy will continue to expand
• Pharmacists will be more integrated on patient care teams
• Utilization of health information and patient technologies by pharmacists
• Improving value through improved medication adherence and persistence
Opportunities Ahead
• Continuing to demonstrate pharmacy value in evolving systems, especially in coordination
of care
• Managing specialty pharmaceutical trends
• Understanding the complexities of payment reform and risk sharing
Challenges Ahead
52

53. Knowing is not enough; we must apply
Willing is not enough; we must do
-------Goethe

54. Thank You!