(851-l04) systematic approaches and strategic alignments

Systematic Approaches and Strategic Alignments for Residency Program

Optimization and ExpansionGift Nweke, PharmD, MS BCPS

System Pharmacy Manager‐ Resident and Student ProgramsNovant Health

DisclosureIn accordance with the ACPE’s and ACCME’s Standards for Commercial Support, anyone in a position to control the content of an educational activity is required to disclose their relevant financial relationships. In accordance with these Standards, ASHP is required to resolve potential conflicts of interest and disclose relevant financial relationships of presenters. In this session:

All planners, presenters, reviewers, and ASHP staff report nofinancial relationships relevant to this activity.

Objectives1. Demonstrate how pharmacy strategic planning may

serve as a mechanism for guiding residency program expansion

2. Identify challenges with residency program management at a large multi hospital system

3. Given a case scenario, evaluate system‐wideinfrastructures created to support residency program improvement

2018 National Pharmacy Preceptors Conference Systematic Approaches and Strategic

Alignments for Residency Program Optimization and Expansion

©2018 American Society of Health-System Pharmacists of 22

NH Pharmacy Services: business within a business

1. Does not include acute due to bundled structure, 2. Cost avoidance includes interventions ($5.6M), P&T Committee ($2M), Target Drug/Antibiotic Stewardship ($1.5M), 3. Utilization Review Accreditation Committee (URAC) accreditation allows our specialty pharmacy to gain/maintain access to payer networks and limited distribution networks, 4. Oncology, NH team members, hepatitis C, HIV, rheumatology, osteoporosis, gastroenterology, 5. Based on estimated contractual rates for acute centers

Pharmacy Services: Organizational Structure Overview

• Acute Care Facility Operations

• Centralized Scheduling

• Procurement• Distribution• 340B• Finance

• Acute Care Clinical Services

• Antimicrobial Stewardship

• Residency & Educational Programs

• Retail Pharmacy

• Specialty Pharmacy

• Infusion• Oncology

• Care Connections

• Discharged patients

• NHMG patients

555 FTEs― 230 Pharmacists― 280 Technicians― 21 Support Staff ― 28 Pharmacy

Residents

• Medication Safety

• Compliance• Automation

SVP Pharmacy ServicesCedric Terrell

SVP Pharmacy ServicesCedric Terrell

Director, Medication Safety & Outcomes Bridget Bridgman

Director, Medication Safety & Outcomes Bridget Bridgman

VP OperationsKathy Doub

VP OperationsKathy Doub

Sr. DirectorPharmacy Operations

Mike Melroy

Sr. DirectorPharmacy Operations

Mike Melroy

Sr. DirectorBusiness Services

Joe Maki

Sr. DirectorBusiness Services

Joe Maki

VP Clinical Christy Ciccarello

VP Clinical Christy Ciccarello

Sr. DirectorClinical Pharmacy

Andrea Parker

Sr. DirectorClinical Pharmacy

Andrea Parker

Sr. Director Outpatient PharmacyJay Brown

Sr. Director Outpatient PharmacyJay Brown

Sr. Director Medication ManagementBecky Bean

Sr. Director Medication ManagementBecky Bean

Pharmacy Services supported by: Executive Vice President/ Chief Medical Officer (EVP/CMO)




Total Pharmacy ResidentsPGY1: 19

Combined PGY1/PGY2: 1PGY2: 9

Pharmacy residency programs for NC and VA

Novant Health Forsyth Medical Center

Winston Salem, NC

921 beds

Advanced Comprehensive Stroke Center

91 bed ED with > 90,000 visits per year

Primary and specialty clinics including: cardiology, neurology, endocrinology, orthopedic surgery and many more

Novant Health is a leading regional healthcare system with 14 medical centers, 450 physician clinics, 100 outpatient facilities in North Carolina, South Carolina, Virginia and Georgia

Novant Health Presbyterian Medical Center Charlotte, NC

531 beds

Home to Novant Health HembyChildren’s Hospital

Named one of the 50 “Best Hospitals” in America

Holds a prestigious three‐star rating for cardiac surgical care from the Society of Thoracic Surgeons

Novant Health UVA Health System Prince William Medical Center

Manassas, VA

130 beds

32‐bed behavioral health unit

TJC accredited programs (AMI, HF, orthopedics, pneumonia)

Washington DC Metro Area

Novant Health Rowan Medical Center Salisbury, NC

268 beds

40‐bed behavioral health unit

Teaching site for Campbell 3rd and 4th year medical students

TJC accredited programs (primary stroke, top performers on key quality measures)

Named one of 60 “Hospitals with Great Orthopedic Programs” by Becker’s Hospital Review

Quality gold plus achievement award by the American Stroke Association

Strategic Planning‐ Aligning Residency Program Expansion with Pharmacy

Growth




Pharmacy’s Role and Residency Program Opportunities

Unique Opportunities in Community Pharmacy

Overall Approach to Strategic Planning

Mission‐ Underlying motivation of businessStrategy‐ Competitive game plan• Objective‐ end points and time frame • Scope‐ business domain• Advantage‐ value proposition and

delivery method Goals‐ Broad outcome • S.M.A.R.T• Measurable objectives

• Consider available metrics Tactics‐ Resources and processes used to reach a goal

Mission

Strategy

Goals

Tactics




Medication Optimization and Outcomes

Medication Optimization and Outcomes cont’d




Ensuring Strategic Alignment with Residency Programs

Key Takeaways Key Takeaway #1

• Start with the strategic plan‐ this will help to highlight under‐resourced pharmacy services and set priorities for growth

Key Takeaway #2• Collaboration is a must‐ partner with other pharmacy leaders

helps to streamline efforts and ensure alignment with departmental/organizational goals

Key Takeaway # 3• Residents can help achieve strategic goals‐ keep departmental

strategic goals and tactics in mind when developing residency programs; these could be opportunities to strengthen and diversify resident learning experiences

Creating a Business Case for Residency Program Expansion




Numerous Ways for Pharmacists to Enhance Value

Marketplace for ambulatory care‐trained pharmacists

Increased presence of clinical pharmacist practitioners needed within medical group clinics to manage chronic conditions

Disease states that demand enhanced training• Diabetes, Coagulopathies, COPD, Heart Failure

Demand far outweighs supply 155 PGY2 ambulatory care programs in existence for 2017‐2018 620 open ambulatory pharmacist positions via online job search

Enhanced recruitment to fill Novant Health positions

Positioned to support a PGY2 ambulatory care residency program?

Large family and internal medicine clinics across the system Diverse practice settings: both urban and rural clinics• Community medicine• Population health• Specialty clinics High clinical acumen of residency preceptors• Multiple graduates of PGY‐1 & PGY‐2 residency programs




Potential Learning experiences and Service commitment

Considerations for a Financial Analysis

Key Takeaways Key Takeaway #1

• Does it align?‐ Be sure that residency expansion plans are within scope of pharmacy goals and can support the practice model

Key Takeaway #2• How is value defined?‐ Speak to specific pharmacy services residents will

participate in and how these generate value (cost savings, revenue, quality measures, safety, etc.)

Key Takeaway #3• Collaboration is a must‐ Partner with Finance and Analytics to review your

financial analysis and obtain feedback on the strength of the “business case” Key Takeaway #4

• Know your audience‐ Does your organization require a business case, proforma or are modifications to budget spreadsheets the preferred approach for FTE requests?




Centralized Residency Program Management

Novant Health Pharmacy Residency Programs Growth Trajectory

System Residency Infrastructure




Residency Program Steering and Advisory Committees

Residency Program Oversight Committees

Operations Oversight Committee• Develops resident staffing model and ensures integration with

clinical practice model • Plans for organizational initiatives requiring resident support• Committee Membershipo Staffing Schedulers o Facility Supervisors or Managers o Residency Program Directors/ designeeso System Clinical and Residency Managerso Ad hoc members as needed

• Meeting Frequencyo April and May each yearo Quarterly touch bases there after or ad hoc as needed

Residency Program Oversight Committees

Quality and Outcomes Research Oversight Committee• Develops research and quality improvement project topics • Creates research processes and timelines/ supports projects

completionso IRB liaison, data requests, statistical support etc.

• Promotes publication and presentation of pharmacy research• Committee Membershipo External: IRB representative, Data/analytics support (Clinical Improvement) o Internal: Residency Program Directors or designees, Clinical Pharmacy

Specialists, System Residency Manager • Meeting Frequency• April through June each year• Quarterly touch bases there after or Ad hoc as needed




Other System Wide Improvements and Innovations

Residents Practice Foundation Management Educational Platforms

• Formal presentations geared towards pharmacy and interdisciplinary teams

Preceptors Onboarding Annual Preceptor Development Session

• ½ day in person retreat for all preceptors Preceptor Evaluation

Case Study ABC Healthy Pharmacy Services has recently launched five new

residency programs (PGY1, Combined and PGY2) and added three resident positions to pre‐existing PGY1 and PGY2 programs. Programs are housed at 10 of the organization’s acute, ambulatory and community facilities spanning the entire geographical footprint. There are a total of 29 pharmacy residents for the current program cycle and proposals are being created to expand PGY1 community residency positions and establish PGY2 programs in key clinical areas. The total number of pharmacy residents projected for ABC Health over the next five years is 64.

Case Study cont’d

Residency program leaders have identified various areas of need for additional support and organization in anticipation of further growth. Common issues vocalized by the group include limited insight on system pharmacy objectives, need for program visibility to pharmacy leadership and organizational support, inconsistent resident onboarding practices, challenges with research and quality improvement initiatives, minimal opportunities for preceptor development or platforms to share best practices, lack of time to devote to accreditation preparedness, no support for recruitment activities and inefficiencies cause by duplicated efforts. Solutions are needed.




What Infrastructures could they implement to support residency program growth?

Dedicated pharmacy manager supporting all educational programsSystem‐ wide committees and governanceStandardized processes and shared platforms for resident and preceptor learning activitiesAll of the above

Which of these is least suitable for standardization across all programs?

Policies and proceduresClinical rotation schedules Onboarding and orientationNone of these are suitable

Frequently, ___________ are necessary to ensure residency programs are adequately supported to meet departmental objectives.

Partnerships with external departments (Human Resources, Marketing, Data & Analytics, IT) Astronomical phenomena (stars aligning, solar eclipses, meteor showers)Celebrity endorsementsActs of Congress




Residency program directors should identify a local coordinator or co‐director to share site specific responsibilities and build a succession plan.

TrueFalse

Key Takeaways Takeaway #1

• Share and share alike‐ Share best practices and resources across programs. Reduce the need to start from scratch

Takeaway #2• Collaboration is a must‐ ask for input, delegate tasks per

individual strengths/ interests, nurture relationships to support residency program objectives

Takeaway #3• Build resilience‐ residency program management runs on short

cycles; advanced planning, a system approach for efficiency and periodic breaks to recharge are integral for success

Systematic Approaches and Strategic Alignments for Residency Program

Optimization and ExpansionGift Nweke, PharmD, MS BCPS

System Pharmacy Manager‐ Resident and Student ProgramsNovant Health




Systematic Approaches and Strategic Alignments for Residency Program Optimization and Expansion ASHP NPPC 2018

Systematic Approaches and Strategic Alignments for Residency Program Optimization and Expansion

Application Exercise (Small group activity) ‐ Aligning Residency Program Expansion with Pharmacy

Growth

Currently, many hospital and health system pharmacy departments are challenged to increase value of services while conserving resources. Residency program expansion is a vital strategic option that enables organizations to do both. Strategic alignment of pharmacy services with residency program implementation is an important method to accelerate growth. Use the Strategic Planning Work Grid to structure your reflections on the following…

1. Identify 1‐2 clinical pharmacy service areas within your organization prioritized for growth.

2. Determine potential resources needed to establish or grow these services and feasibility of implementing a pharmacy residency program within this areas.

3. What challenges do you anticipate in launching the pharmacy service?

4. What strategies will you implement to overcome them?





Pharmacy Strategic PlanStatus Key On Track Delayed At Risk Complete

Goal ‐ Tactic ‐ Subtactic 2018 2019 2020 Owner Leader StatusCritical Success Factors/

Gap Assessment MetricsRevenue Generated or Cost Avoidance

Estimated Amount $

Goal 1: Tactic 1: Subtactic # Subtactic Name 2018 2019 2020 Owner Leader

Tactic 2:Subtactic # Subtactic Name 2018 2019 2020 Owner Leader


Workstream Medication Optimization & Outcomes





Status Key On Track Delayed At Risk Complete

Goal ‐ Tactic ‐ Subtactic 2018 2019 2020 Owner Leader StatusCritical Success Factors/

Gap Assessment MetricsRevenue Generated or Cost Avoidance

Estimated Amount $

Goal 2: Tactic 1: Subtactic # Subtactic Name 2018 2019 2020 Owner Leader



Workstream Medication Optimization & Outcomes





Systematic Approaches and Strategic Alignments for Residency Program Optimization and Expansion

Interactive Scenario (Small group activity) ‐ Creating a Return on Investment to Justify Residency

Program Expansion

Despite the various merits and benefits associated with pharmacy residencies, such as minimizing costs of labor resources, expenditures associated with program implementation are considerable and must be justified prior to approval. While federal programs currently incentivize PGY1 pharmacy program expansions, similar support for PGY2 programs are not available. Use the Return on Investment

Worksheet to develop a business case for a PGY2 residency program.

Consider the following…

1. Associated expenditures a. Salary and benefits b. Travel and conference c. Mileage for system offsite training and orientations d. Accommodations for offsite rotations

2. Potential Cost Savings and Revenue a. Value from service commitment model b. Revenue capture from unique pharmacy services c. Additional capacity for student precepting d. Local or national awards or grants

3. How can workflow alignment, scheduling and structuring of learning experiences help to maximize revenue and savings while still maintaining program quality and integrity?





Pharmacy Business Plan

Return on Investment Calculation‐ Residency Programs

Note: Consulting with a departmental/organizational Finance representative to validate return on investment analyses is highly recommended. These individuals can provide data and statistics of relevance to the organization and ensure financial projections are based on rational premises.

Year 1 Year 2 Year 3

1 Savings/Revenue

2 Cost avoidance (hard dollar savings)

3 Reduced PRN hours

4 CMS Reimbursement

5 Margin from Revenue Enhancement

6 Project Savings

7 Gross Savings/Revenue

8 Operating expenses 9 Expenses (non-salary)

10 Pharmacy Resident FTE (#)

11 Pharmacist Benefits (26% of salary)

12 Total Expenses

13 Total Cash Flow

14 Discount 12.0%

15 Total Cash Flows $$

Total incoming revenue/savings (Sum of line

13; Years 1 through 3)

16 Net Present Value $$

Present value of future cash flow (NPV[Line

14, Line 15])

17 ROI %

Net Profit relative to investments over a

period of time [(Line 15/Sum of Line 12;

Years 1 through 3]*100

2018 Budget Facility FTEʹs

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(851-l04) systematic approaches and strategic alignments

Documents