The vertically integrated pharmacy department

Pharmacy's challenges and opportunities during a transition from a traditional hospital to an integrated health system are discussed with reference to the experience of a medical center in Vancouver, Washington. When a traditional hospital makes the transition to an integrated health system, pharmacy directors must consider how the core business will be affected, how pharmacy can add value, and how to best apply the skills of the pharmacy department. A well-trained staff that shares a view of the new organization and that can think outside the traditional hospital paradigm is required. New health systems will focus on quality-related outcomes at low cost and on disease management. Partnerships between providers and health care staff will be beneficial. To compete for capitated contracts, health systems will need to deliver services other than acute care to a broad geographic area, and primary care will be more prominent. There will be a shift toward outpatient services, and pharmacy departments will be under increasing pressure to develop outpatient pharmaceutical services. Pharmacy departments will also need to develop treatment guidelines for outpatients and to better manage drug costs by working with new business clients, improving continuity of care, increasing patients' access to care, having pharmacists provide hospice care, and implementing remote prescription-order entry. New health systems will need to have a clear understanding of how their core business is changing; the organizational strategy of a health system must include effective communication of change to staff members with the goal of overcoming traditional thinking.