Development of Summit Recommendations

In November 2020 ASHP appointed a 14-member steering committee, comprising specialty pharmacy managers, clinicians, technicians, and health-system chief pharmacy officers, to provide guidance on high-level planning for a 4-day virtual summit. This committee worked with ASHP staff to develop a set of proposed recommendations for consideration by the summit invitees. The initial proposed recommendations took into account the inaugural ASHP National Survey of Health-System Specialty Pharmacy Practice, guidance from the Summit Steering Committee and the Section of Specialty Pharmacy Practitioners Executive Committee, ASHP’s PAI 2030, and patient care, practice model, and marketplace trends. This resulted in an initial set of 80 proposed recommendations that were subsequently placed in the Web-based survey tool Qualtrics XM (Qualtrics, Provo, UT), and sent to the steering committee and the ASHP Section of Specialty Pharmacy Practitioners (SSPP) Executive Committee for review and comment. The survey asked these leaders to consider each proposed recommendation and respond to the questions (a) Does this recommendation identify an aspirational goal? and (b) Does this draft recommendation identify a gap in practice? Survey respondents also had the opportunity to provide comments, including making edits to language and pointing out omissions of key concepts. Additionally, the survey instrument provided to these 2 groups asked for feedback on the proposed domains, which were decided on as the following:

• Practice Model and Performance

• Patient Care Services and Access

• Workforce Competency, Credentials, and Culture

• Safety, Quality, Outcomes, and Value

• Data and Technology

• Business Development

• Leadership, Research, and Advocacy

  The outcomes of this process were used to develop a proposed set of 74 recommendations for the summit voting participants to use during their deliberations.

Pre-summit survey of summit consensus panel participants

The summit was an invitational event held February 2–4, 2021. Due to COVID-19 pandemic restrictions, the summit was conducted in a virtual meeting format. ASHP staff invited participants selected from a panel of 158 ASHP members who responded to a September 2020 Web-based survey to nominate themselves or others to serve on the summit consensus panel. The Summit Steering Committee and SSPP Executive Committee were also invited to participate.

The summit had 75 voting participants representing directors of specialty pharmacy; specialty pharmacy managers; clinical and outcomes specialists; ambulatory care pharmacy leaders; payer, specialty pharmacy network, and pharmaceutical industry executives; and chief pharmacy officers. These participants represented 32 states. Additionally, there were participants representing specialty pharmacy organizations and networks.

All of the voting participants were requested to complete a pre-summit Qualtrics XM survey of 74 proposed recommendations and were asked to indicate their level of agreement with each of the proposed recommendations on a 4-point scale (strongly agree, agree, disagree, and strongly disagree). Additionally, each summit participant was provided an open text comment opportunity (“Please explain any reservations you have or substantive revisions you would like to see for this recommendation.”) for each proposed recommendation. All voting summit participants completed the pre-summit survey. The responses from the survey resulted in 7 recommendations that met or exceeded 75% “strongly agree,” 41 recommendations that met or exceeded a combined 95% “agree” and “strongly agree,” and 32 recommendations that had less than 75% “strongly agree” or a combined 95% “agree” and “strongly agree.” The responses indicated a high degree of agreement, so analysis was conducted to further stratify the results in a manner to prioritize recommendations in preparation for the summit discussions and deliberations. The results of this survey were used to prioritize proposed recommendations for additional discussion and refinement in the small group discussions on day 1 and day 2 of the summit.

Small group discussions

The summit participants were divided into 8 small groups, with one participant serving as the discussion facilitator, utilizing virtual meeting technology. The facilitators were representatives from the steering committee or the SSPP Executive Committee and supported by a secretary from the ASHP staff. The small groups met on days 1 and 2 of the summit.

The 68 proposed recommendations not meeting a predetermined threshold of 75% “strongly agree” and a combined 95% “agree” and “strongly agree” were prioritized for small group discussion. The 6 proposed recommendations that did meet the threshold were included for small group discussion but listed as last items for discussion. The recommendations were distributed amongst the small groups so that each proposed recommendation was assigned to 2 separate small groups. Each group was asked to discuss and address the following:

• Will the recommendation meet an unexpected need?

• Will it solve a problem?

• Will it improve something?

• Is this relevant and/or impactful to most specialty pharmacy practice settings?

• Are we heading in the right direction? If not, what are your suggestions to get on track?

• Why is this recommendation important for specialty pharmacy practice advancement?

• Are there needed edits to proposed recommendations?

Mid-point consensus survey

Due to the need to conduct the summit in a virtual format, an additional mid-point survey was conducted to gauge progression of consensus building, integrate outcomes from the small group discussions, consider new recommendations, and identify the recommendations for highest priority for the virtual all-participant open discussion on day 4 of the summit. ASHP staff collated all of the discussions and decisions from the small groups at the end of day 2 of the summit to prepare a new Qualtrics XM survey for summit participants to complete on day 3 of the summit (participants agreed to be available on day 3 exclusively for completing this mid-point survey). The survey included 74 proposed recommendations that reflected proposed edits, combining of recommendations, and new recommendations. Participants were asked to indicate their level of agreement with each of the proposed recommendations on a 2-point scale of “approve” and “disapprove.”

Large-group session

Day 4 of the summit was dedicated to providing the opportunity for participants to discuss any proposed recommendation that did not meet the predetermined 80% approval threshold in the midpoint survey. All 74 recommendations met the predetermined 80% approval threshold. Fifty-two recommendations met or exceeded 90% approval, 16 had approval of 85% to 89%, and 6 had approval of 81% to 84%. However, after reviewing the participant comments from the midpoint survey, summit leaders determined that 6 recommendations warranted large-group discussion. These recommendations were discussed, edited in real time (which included some merging of proposed recommendations), and voted on using the GoToWebinar polling app (LogMeIn, Inc., Woburn, MA), and each reached over 90% final approval by the end of the exercise. The summit surveys and small group and large group consensus processes resulted in a final set of 71 recommendations and 7 domains.

Public comment and ASHP Board approval

The 71 recommendations were prepared for public comment. ASHP messaged the opportunity for public comments from March 3 through March 17, 2021, via MagnetMail messaging (Higher Logic, Arlington, VA) to all ASHP members that included a Web-based survey tool. There was a high level of agreement, comments were taken into consideration, and the final set of consensus recommendations were presented to the ASHP Board of Directors. The Board approved and accepted the recommendations as official outcomes of the summit on April 15, 2021.