Adherence to certain strategies can aid pharmacists in successful navigation of our increasingly collaborative healthcare landscape, according to research presented by Jason Bergsbaken, PharmD, and Mary Mably, RPh, BCOP, at the 11th annual Hematology/Oncology Pharmacy Association conference.
Our Current Healthcare Landscape
"The number of hospital mergers and acquisitions has more than doubled from 50 in 2009 to 105 in 2012," said Ms Mably, Pharmacy Oncology Coordinator, University of Wisconsin Hospital and Clinics, Madison. "The threat of managed care drove the merger and acquisition activity in the mid-'90s as expected, it increased again in 2010 with the Patient Protection and Affordable Care Act."
A confluence of powerful forces, consisting of the Affordable Care Act, declining reimbursement rates, and increasing overhead costs, are driving the increase in demand for oncology affiliation agreements, she added. "Many independent hospitals or smaller healthcare systems are not sufficiently capitalized to effectively reinvest and reinvent themselves; similar challenges are faced by physicians operating in small group practices as they struggle to cover traditional costs such as malpractice insurance, as well as the added burden of the required conversion to electronic medical record" Ms Mably stated.
Oncology Affiliation Agreements
Oncology affiliation agreements are increasing in frequency, and challenges and benefits exist for both local and parent organizations. Benefits to local affiliates include using the expertise and reputation of the parent organization, and improving their market share."Typically, the parent organization has spent considerable time and resources developing a brand or a reputation that resonates with patients within a given area," explained Dr Bergsbaken, Pharmacy Coordinator, Regional Oncology Services, University of Wisconsin Hospital and Clinics." In addition, the parent organization may offer expertise or additional clinical resources to local affiliates; when we couple the increase in resources with the reputation, there is a possibility of improved local affiliate market share." Potential benefits for parent organizations include broadening their regional reach and brand, sharing their management fees and revenue with local affiliates, and increasing their referrals and research accrual.
Within oncology affiliation agreements, expected challenges also exist. The Federal Trade Commission has denied proposed mergers or affiliations because of perceived risk to patients and employees.
The Role of the Pharmacy Administrator
"The first role of the pharmacy administrator within oncology affiliation agreements is to secure a seat at the table where discussions will be held and decisions will be made," discussed Ms Mably. "Administrators should be proactive and not reactive; this ensures that the pharmacy will be able to contribute up front to the affiliation agreement."
The pharmacy administrator should also be able to demonstrate the value of pharmaceutical care to the oncology affiliation agreement by knowing and communicating the anticipated pharmacy deliverables (eg, leadership and practice management, quality and performance improvement mechanisms such as cost-saving or other performance-improving initiatives, and quantifiable education and training measures). "All deliverables need to be supported by hard data, such as the number of guidelines available, committees already functioning, and resources that are located within the pharmacy department," she added.
"Pharmacy administrators should be able and ready to communicate the pharmacy's role within the contract upward and outward," Ms Mably emphasized. This communication should include implementation items, resources needed by the pharmacy department to deliver these items, estimated time requirements of all pharmacy deliverables , and a timeline for the implementation of the contract.
Pharmacy administrators should be involved in the development of your vision, or your end goal, according to Dr Bergsbaken. A vision should be clear and realistic, and should be communicated to staff to ensure their engagement and involvement in the implementation of activities.
"Culture is the behavior that someone is performing in an organization, and the meaning that's tied to that behavior, so it is likely that when you enter into these types of affiliations there are going to be cultural differences to overcome," he added. Dr Bergsbaken suggests working with fellow leaders to make cultural integration an agenda item, diagnosing and observing cultural differences by spending time with new partners and becoming familiar with their policies and procedures, and developing a plan for cultural integration.
Guidelines for communication must also be addressed to ensure successful navigation of an oncology affiliation agreement. Pharmacy administrators should know their audience and ensure that messages being communicated are done so appropriately. Dr Bergsbaken also stressed the importance of face-to-face communication, especially early in the affiliation, and advised the use of electronic communication only later down the line.
"Both organizations will [most likely] be undergoing some sort of change when entering into this agreement," Dr Bergsbaken stated. "Change can benefit you both, so it's important to take a structured approach to this." Crucial emotional factors should be evaluated, employee engagement should be monitored, and pharmacy-related goals should be set on an organizational level to maintain accountability. "It's important to identify some small wins that you can work on with your new partner in order to first develop trust, and then you can tackle some of your larger items," he added.