INTEGRATION OF PHARMACY SERVICES IN MULTIFACILITY HEALTH SYSTEMS

To advocate that pharmacists are responsible for organizational efforts to standardize and integrate pharmacy services throughout the entire pharmacy enterprise in multifacility health systems and integrated delivery networks; further,

To educate health-system administrators about the importance of pharmacy leadership in setting system-wide policy regarding the safe and effective use of medications; further,

To advocate for the regulations and resources needed to support efforts to achieve optimal patient health outcomes in multifacility organizations.

Rationale

Data from a fiscal year 2021 American Hospital Association survey of hospitals indicate that 3514 of 5157 (68%) of community hospitals were part of either a system or a network, reflecting the evolution of the healthcare enterprise from single hospitals to integrated systems and networks. Multiple hospitals organized and owned by the same system have been common in the U.S. for decades, but the rapidly changing marketplace will invariably lead to a future in which every hospital in the country will be part of a system. These systems have become increasingly complex as they also delve into nonhospital-based businesses and seek to standardize and gain economies of scale across the organization.

These new organizations and the recognition of the importance of medication management to the overall health of these organizations have led to new roles and new challenges for pharmacy leaders (see ASHP Statement on the Roles and Responsibilities of the Pharmacy Executive). The pharmacy enterprise is more sophisticated and corporate in its nature than in the past. Pharmacy leaders at both the local hospital and at the corporate levels have to more than ever examine their pharmacy services in the context of the goals and needs of the organization or health system and determine the most efficient and effective means to provide these services. Leadership of the pharmacy must evolve from a department leader in a single facility to an effective corporate leader of medication use across a wide array of business units, care settings, and organizations. Centralization of medication management services is no longer confined to drug distribution but also includes human resources management, integrity of the electronic health record and related patient-care information, and oversight of various business partners. Pharmacy leaders within these evolving health systems will have many challenges, ranging from communication among the pharmacy management team, decisions on pharmacy infrastructure purchases and contracting, identification of critical services and standardization, succession planning and workforce development, supply chain management, human resource coordination, and strategic planning across diverse hospitals within the system. An additional challenge to these health-system pharmacy leaders is the need to coordinate and integrate pharmacy services across larger geographical regions to improve cost-effectiveness and patient care outcomes.

The nature and culture of decision-making will be changed as some decisions become more centralized and corporatized and new practice models are developed to capitalize and adapt to the changing marketplace. Especially as merged systems extend beyond local and regional markets, healthcare will likely become even more business-like in its decision-making, and fewer decisions will be made at the local facility level. The pharmacy enterprise will need to adapt to this changing environment. Many important decisions that influence medication-use policy will be made at the level of corporate leadership, and it will be critical that pharmacists provide leadership in this corporate decision-making. The ability to demonstrate the financial impact of pharmacy services will be critical and the development and implementation of effective drug-use policy across the enterprise will be crucial to success.

Along with increasing consolidation and integration of health systems, the business model for healthcare is also evolving. Pharmacy leaders will need to become familiar with changing business imperatives and align the pharmacy business plan with that of the health system. Planning must integrate at both the strategic and tactical level. Pharmacy needs to be envisioned as a service rather than a department. These changes have resulted in the need to evaluate best practices, legal and regulatory requirements, and leadership structure.