Becker’s asked pharmacy executives from hospitals and health systems, along with academic medical centers and universities across the U.S. to share what trends they deem dangerous.
The 18 executives featured in this article are all speaking at Becker’s Healthcare 3rd Annual Fall Chief Pharmacy Officer Summit, set for Nov. 4-6 at the Swissotel Chicago.
To learn more about this event, click here.
If you would like to join as a speaker or reviewer, please contact Mariah Muhammad at mmuhammad@beckershealthcare.com or agendateam@beckershealthcare.com.
As part of an ongoing series, Becker’s is talking to healthcare leaders who will speak at our conference. The following are answers from our speakers at the event.
Question: What is the most dangerous trend in healthcare today?
Madeline Camejo. Vice President of Pharmacy Services and Chief Pharmacy Officer of Baptist Health South Florida (Coral Gables, Fla.): I think one of the most dangerous trends in healthcare today is treating workforce challenges as a temporary operational issue rather than a strategic threat to patient care. If we continue asking clinicians to do more with less, we risk creating a system that appears efficient on paper but is ultimately unsustainable in practice.
At the same time, people are living longer with multiple chronic conditions, requiring increasingly complex medication regimens. Healthcare organizations across the country are facing greater clinical complexity, persistent workforce shortages, fragmented care, mounting financial pressures, and growing demand for cell and gene therapies and related services.
The future of healthcare depends on redesigning care models, embracing technology responsibly, and investing in the people who deliver care every day. Without greater investment in care coordination, clinical decision-support technology, and workforce development, both patient outcomes and affordability will continue to suffer.
The greatest risk is not any single innovation or disruption; it is allowing complexity to outpace our ability to deliver safe, coordinated, patient-centered care.
Cassandra Redmond, PharmD. Associate Chief Operating Officer of Penn Medicine at Home (Philadelphia): In my opinion the most dangerous trend in healthcare today is the growing mismatch between patient complexity and the capacity of the healthcare system to deliver timely, coordinated care. Patients are aging and require more coordinated care than ever before, while clinicians face workforce shortages, administrative burden and financial pressure. If we do not redesign care delivery, we risk creating a system that is technically advanced but increasingly inaccessible to patients who need it most.
Bonnie Levin, PharmD. Vice President of Pharmacy Services at MedStar Health (Columbia, Md.): One of the most concerning trends in healthcare is the rise in the uninsured population. Reduced access to coverage leads many patients to postpone care, resulting in higher acuity when they eventually seek treatment. Hospitals continue to provide care regardless of insurance status, which drives increases in charity care, uncompensated services, and bad debt, further straining health system financial performance and long-term sustainability. Some hospitals will close (especially with potential changes to 340B), requiring patients to drive longer distances to seek care.
Nephthalee Edmond Tefera, PharmD, MBA, BCPS, ACCA, Director, Pharmacy, MedStar Harbor Hospital (Columbia, Md.): I think one of the most concerning trends in healthcare today is how quickly the complexity of care is growing. Patients have more complex needs, technology is changing rapidly, and healthcare teams are being asked to adapt just as quickly. The risk is that our systems and processes don’t always evolve at the same pace.
As a healthcare leader, I believe we have to continually look at how we work and where we can make things simpler and safer for both our patients and our teams. Technology and automation can certainly help, but for me, the question is always whether they solve a real problem and make the work better. We also can’t lose sight of our people. Investing in them, listening to them, and including them in how we improve care is just as important as any new technology we introduce.
Long D. Trinh, PharmD. Senior Director of Pharmacy of MedStar Georgetown University Hospital (Washington, D.C.): The most dangerous trend in healthcare today is the growing imbalance between rising costs, workforce strain, and the tough decisions organizations must make about where to invest increasingly limited resources. Health systems continue to face significant external forces, including nationwide healthcare workforce shortage, persistent non-labor inflation by global supply chain challenges, and reimbursement remaining relatively flat, creating significant pressure on operating margins. The danger is not simply financial but is the risk that prolonged resource constraints contribute to caregiver burnout, diminish organizational resiliency, and limit the investments needed to remain innovative and competitive in a rapidly evolving healthcare landscape. Success will require a relentless focus on business transformation, highly reliable processes, elimination of waste through lean improvement, and thoughtful adoption of automation and robotics. At the same time, leaders must carefully evaluate artificial intelligence and other emerging technologies to ensure they augment human expertise, enhance care delivery, and improve operational performance. Ultimately, our responsibility is to invest strategically in both our workforce and system design so that we can translate vision into execution and deliver exceptional, safe, and sustainable patient care for the future.
Kelley Curtis, PharmD. Chief Pharmacy Officer and Vice President of Pharmacy and Lab COE at St. Luke’s Health System-Idaho: The most dangerous trend in healthcare today is the growing disconnect between financial sustainability and the patient experience. Health systems are under tremendous pressure to reduce costs, respond to reimbursement changes, navigate workforce shortages, and adapt to an increasingly complex regulatory environment. Those pressures are real, but they can also pull organizations into making decisions that solve today’s budget problem while creating tomorrow’s access problem.
In pharmacy, I see this every day. We’re being asked to do more with less while managing rising drug costs, new payment models, 340B uncertainty, and rapidly expanding specialty therapies. The organizations that will succeed are the ones that resist treating pharmacy as a cost center and instead recognize it as a strategic driver of clinical quality, patient access, and financial performance. We feel lucky to have the support we do at St. Luke’s but I know it’s not the case in all health systems.
Technology and AI will certainly change how we work, but they are not the strategy. The strategy is building integrated care models that make it easier for patients to receive the right medication at the right time while giving clinicians the tools they need to focus on patient care. If we lose sight of that, no amount of technology will make up for it.
Eric Huckins, PharmD. Vice President of Business Development, Lumicera Health Services at SSM Health (St. Louis): The most dangerous trend in healthcare today is the growing misalignment of incentives across manufacturers, payers, PBMs, health systems, and providers. Over the past decade, we have seen a continuous cat-and-mouse game of restrictions and countermeasures, from efforts to limit 340B participation and narrow specialty pharmacy networks to strategies designed to capture copay assistance dollars. While each stakeholder is pursuing legitimate business objectives, the unintended consequence is that patients are too often caught in the middle. The result is increased complexity, delays in therapy, barriers to access, and higher administrative burdens that can ultimately compromise care. Rather than continuing to layer new restrictions on top of old ones, the healthcare industry must find ways to align incentives, compromise on competing objectives, and create sustainable solutions that prioritize patient access and outcomes. Patients should never bear the consequences of fragmented policies and competing financial interests when seeking life-saving medications.
Elaine Huang, PharmD. Associate Chief Pharmacy Officer of UW Medicine (Seattle): From what I have seen from other health systems and am learning to avoid at UW Medicine is that the greatest risk isn’t just staffing shortages but it’s losing experienced clinicians due to burnout. Given the growing gap between the complexity of care and the resources available to deliver this care, healthcare is becoming unsustainable. I think that if organizations respond only by cutting costs without redesigning care, we risk compromising quality, patient safety, and the experience for patients and staff. As a leader, I know that my responsibility isn’t to tell people to work harder, but it’s to improve productivity through innovation and investing in technology that truly works for the frontline staff in order to reduce administrative burden and standardize processes.
Daiana Huyen. Director of Pharmacy Services and Operations at North Olympic Healthcare Network (Port Angeles, Wash.): On July 31, HRSA published a Federal Register notice reviving its 340B Rebate Model Pilot, the same mechanism proposed in 2025 and paused by a court injunction. It’s back, and broader.
If HRSA’s 340B rebate pilot takes effect January 1, 2027, our pharmacy will need to pay full price upfront for roughly 25 drugs subject to the model, then wait to receive 340B discount back as a manufacturer-issued rebate rather than getting it at the point of sale.
The rebate model will strain our cash flow significantly. We will no longer be able to pass on the 340B savings to our qualified patients. It will require new administrative infrastructure to track claims, submit documentation to participating manufacturers, and reconcile rebate payments against expected amounts.
We need to prepare now to ensure that we build a cashflow buffer, mapping out a drug formulary/therapeutic interchange to be able to substitute the impacted 25 drugs. We need to invest in claim tracking infrastructure, and staff assignments/FTE.
Jason D. Trahan. Executive Director of Pharmacy Business at ECU Health (Greenville, N.C.): The current impact of rising prescription costs, increased restrictions, uncertainty around the future of the 340b program, and fragmented patient experience are compounding issues facing healthcare nationally, but particularly in rural communities. As pharmacy leaders, we are tasked with delivering complex, high-cost therapies while facing increased financial headwinds and other administrative barriers. Coupling these factors with ongoing workforce shortages and patient challenges with pharmacy access in the rural communities we serve has made it more difficult for patients to navigate their healthcare needs. At ECU Health, we’re responding by building an integrated pharmacy ecosystem with our rural reality in mind that connects hospitals, specialty, home infusion, and ambulatory pharmacy services to improve access to medications, patient outcomes, and affordability. We’re also investing in automation platforms, analytics, and operational efficiencies to ensure we can continue to deliver high-quality care across our enterprise in a financially sustainable way.
Margaretta L. Kearson, PharmD. Clinical Pharmacy Manager of Memorial Regional Hospital (Hollywood, Fla.): From my perspective as a tenured, 20-plus year pharmacy leader within the Memorial Healthcare System and Clinical Pharmacy Manager of Memorial Regional Hospital, the most dangerous trend I see is the growing gap between insurance restrictions and access in conjunction with patient need.
As health systems and payors negotiate increasingly restrictive contracts, patients face delayed and denied care, driving up avoidable admissions and decreasing access to the very services meant to sustain life and manage chronic disease. It is heartbreaking to run centers of excellence within our institution, not limited to cardiology, solid organ transplant, behavioral health, rare diseases, and oncology, only to watch newly diagnosed and long-term patients lose in-network coverage or find their carrier without a contract at all. It is extremely disheartening when family members and neighbors are negatively impacted.
As a pharmacy leader, I believe it’s imperative that we build relationships through our professional societies, engage senior leadership with health care systems, and stay directly involved wherever these decisions are made from state legislation to insurance contracting. It is also beneficial to engage our local civic and community organizations and places of worship to engage and educate our community about knowing their insurance coverage. Being at and actively engaging in decisions at any available table is how we shape the future of pharmacy and protect our patients, rather than letting insurers and regulators decide for us. I worry about professionally and personally.
Fatimah Muhammad. Director of 340B Pharmaceutical Services, Specialty Pharmacy, Drug Replacement, and ADM Pharmaceutical Services at Saint Peter’s University Hospital (New Brunswick, N.J.): The most dangerous trend in healthcare today is the widening disconnect between policy decisions and the operational realities of delivering patient care. I see this firsthand in pharmacy, where rising drug costs, reimbursement pressures, manufacturer restrictions, and continued uncertainty surrounding the 340B program increasingly threaten access to essential medications and services. Safety-net hospitals are being expected to manage greater clinical complexity and serve more vulnerable populations while operating with fewer resources and less financial predictability. When policy is developed without a clear understanding of its downstream impact, the consequences extend beyond a hospital’s balance sheet. They delay treatment, restrict access, and deepen health disparities. Healthcare leaders must approach pharmacy affordability, patient access, and organizational sustainability as one interconnected strategy rather than separate priorities. Our responsibility is not simply to respond to change but to anticipate it, shape it, and build systems that protect access before patients feel the impact.
John Mildenberger, PharmD. Specialty Pharmacy Manager, Senior Clinical Lead Pharmacist and Compliance Officer at Sidney Regional Medical Center (Neb.): The most dangerous trend in healthcare today is that our best treatments may never reach the patients who need them. Between the 340B payment cuts proposed in CMS’s CY 2027 OPPS rule and the changes coming to Medicaid, this problem will only compound. IQVIA’s 2026 U.S. Medicine Use Trends report found that nearly two-thirds of prescriptions for newly launched medicines went unfilled in the first year on the market, with 49 percent rejected by payers and 17 percent abandoned by patients after approval. By year four, more than half still go unfilled. Over the next five years we expect 50 to 55 new medicines to launch annually, many of them the specialty and oncology therapies our patients are counting on. We are accelerating innovation and simultaneously widening the gap between what exists and what a patient can actually pick up. At our 25-bed critical access hospital in western Nebraska, that is not an abstraction; we have seen patients lose access to their treatment as they attempt to run the insurance coverage gauntlet. Medical innovation is only as good as the end product and the patient impact it creates, so our greatest danger is generating wonderful new treatments that deliver little or no broad patient benefit. After all, what good is a treatment if you are unable to use it? Health systems can begin solving this by doing what we do best, which is putting patients at the center of their care. For us that has meant building the pharmacy infrastructure to keep the patient and the prescription together instead of assuming someone else would.
Faisal Sahawneh, PharmD. Regional Manager of Pharmacy Infusion Services at Loyola University Medical Center (Maywood, Ill.): One of the more dangerous trends that I’ve seen in the hospital and outpatient infusion settings is the disruption potential to our medication and medical tools and supply chains. Extreme weather events in a port city or plant closures due to natural disasters can result in severe and persistent shortages of IV fluids, medical supplies, and chemotherapy medications. In other cases, the lack of economic viability for producing a particular drug can take precedence over its clinical importance as well. We’ve consistently had to manage such cases via emergency rationing protocols or opting for an entirely different treatment path due to such disruptions. In a globalized world, supply chain resilience remains integral to delivering the care patients actually need.
Sterling Elliott, PharmD. Clinical Pharmacist Lead of Ambulatory Surgery Practice, Surgery and Procedures at Northwestern Medicine (Chicago): The growing divergence of revenue streams and operating costs concerns me more than any other trend in American healthcare. Practitioners and institutional service lines are facing daily threats to the volume of revenue available. Third party payers are driving down reimbursements at lightning speed while refusing participation altogether. As costs to provide care skyrocket, the healthcare system, and pharmacy, to a large degree, is facing historic levels of pressure. The viability of access for patients is under as great a threat as I can remember. Moving forward, the challenge is to identify new lines of reimbursable revenue that will add value to the patients and the fiscal health of America’s institutions. Pharmacy is poised to be a part of this evolving solution, and I’m optimistic that creative practitioners and leaders can shape a new direction of our industry.
Demilade Haastrup, PharmD. Manager of RSC Pharmacy, Division of Pharmacy Services at Children’s National Hospital (Washington, D.C.): The most dangerous trend in healthcare today is the normalization of doing more with less. In every aspect of healthcare, we continue to ask clinicians and support teams to absorb increasing operational, regulatory, technological, and patient care demands without a proportional investment in workforce development, mentorship, infrastructure, and process redesign. Practicing in pediatric healthcare, the stakes are especially high because our patients are among the most vulnerable, and medication use is often more complex and individualized than in adult populations. As a firm advocate for innovation, automation, and artificial intelligence, which offer tremendous opportunities, pharmacy and other healthcare leaders must not view them as substitutes for adequate staffing, strong clinical governance, and a culture of safety. At Children’s National Hospital, we have seen that sustainable improvements come from empowering frontline teams, standardizing workflows, thoughtfully leveraging technology, and maintaining a relentless focus on patient safety. The organizations that will be most successful are those that balance innovation with operational resilience and continue investing in the people who deliver care every day.
Samantha Shi, PharmD. Director of Pharmacy at USC Norris Comprehensive Cancer Center (Los Angeles): Aside from the increasingly complex reimbursement models and financial toxicities associated with novel and advanced oncology treatments, from a patient quality and safety perspective, I believe persistent oncology drug shortages have become one of the most dangerous systemic threats to delivering optimal cancer care. Oncology drug shortages pose an especially alarming threat because there are often no comparable therapeutic alternatives available, fundamentally altering treatment plans or introducing significant additional toxicities. As we speak, several essential chemotherapy agents, including carboplatin, cisplatin, ifosfamide, and doxorubicin, are listed on the ASHP Current Drug Shortages Bulletin. Not having the indicated drug available means that a patient may not receive the treatment proven to be most effective for managing their cancer, potentially compromising a curative intent or disrupting a sustained remission. When institutions are forced to turn to the gray market, these same medications are often sold at exponentially inflated prices while raising concerns about product integrity. Oncology pharmacists and pharmacy leaders are constantly diverting their time and efforts away from direct patient care to manage drug procurement and shortage mitigation. Drug shortage management has become the norm for cancer centers, adding yet another challenge for patients who are already battling tremendous physical and emotional distress.
Jason R. Smith, PharmD. Chief Pharmacy Officer of University of Rochester Medical Center (N.Y.): The most dangerous trend in healthcare today is the shift in funding cuts for Medicaid, the Health Insurance Marketplaces, Medicare along with cuts to 340B safety net hospitals that take care of this most vulnerable patient population. The proposed OPPS reimbursement cuts will result in a lower reimbursement from ASP – 6% to an ASP – 33.4% to 340B hospitals coupled with the accelerated recoupment to keep budget neutrality from the previous attempt to cut rates that was overturned will have a significant impact on safety net hospitals. Since this is overall budget neutral it does not save Medicare but rather shifts 340B savings away from the safety net, which as I mentioned take care of the most vulnerable population. Safety net hospitals are barely breaking even today, and cuts to the 340B program will result in tough choices for safety net providers to find a way to continue to provide services.
Alfred L’Altrelli, PharmD. Chief Pharmacy Officer of Memorial Medical Center Health System (Springfield, Ill.): The most concerning trend in healthcare that I am seeing today is the widening gap between the increasing complexity of medication regimens and the capacity of healthcare systems to manage them safely and effectively.
Medication regimens are becoming more sophisticated, the resources needed to optimize, monitor, and manage these therapies are under growing strain at the same time. Add to this that many healthcare organizations have yet to fully leverage available technologies that could enhance medication safety, improve efficiency, and support better patient outcomes. Plus, many organizations have not fully utilized the scope and expertise of pharmacists and pharmacy technicians despite our proven ability to improve medication safety, optimize therapy, reduce healthcare costs, and enhance patient outcomes. All this at a time when medication management is becoming increasingly complex, pharmacy professionals represent one of healthcare’s most underutilized resources.
As health systems are caring for older, sicker, and more medically complex patients than ever before, the number of available therapies continues to expand through specialty medications, biologics, cell and gene therapies, pharmacogenomics, and precision medicine. While these advances have transformed our ability to treat disease, they have also created unprecedented complexity in medication management. Polypharmacy is increasing, treatment plans are becoming highly individualized, transitions of care are more challenging, and the volume of clinical information requiring interpretation continues to grow. Organizations that fail to fully leverage pharmacy expertise will struggle to safely implement and manage many of these advanced therapies. The result is a healthcare environment where medication-related complexity is increasing faster than many systems, processes, and workforce models are evolving to support it.
If you look more at precision medicine, it continues to advance, and we should be leveraging tools such as pharmacogenomics more routinely to tailor therapies, improve outcomes, and reduce adverse drug events. Then, at the same time, we have healthcare organizations that face persistent workforce shortages, financial constraints, and administrative burdens that limit the time clinicians can devote to direct patient care and restrict leaders’ ability to invest in innovative programs and technologies.
As a pharmacy leader, I worry that these competing forces are creating an environment where medication-related risks may outpace our ability to prevent harm and inhibit our ability to heal. Medication errors, adverse drug events, antimicrobial resistance, and breakdowns during transitions of care remain significant threats when clinical resources are stretched too thin.
While technology, automation, predictive analytics, and artificial intelligence are transforming healthcare, they are not substitutes for clinical judgment or healthcare professionals. The greatest danger is assuming that advanced technologies alone can solve the increasingly complex challenges associated with medication management. Technology should augment, not replace, the expertise of pharmacists and other frontline clinicians who interpret data, identify risks, collaborate with care teams, and intervene before harm occurs.
The future of safe medication use will depend on our ability to successfully integrate human expertise with technological innovation. The healthcare systems that achieve this balance will be best positioned to improve outcomes, reduce preventable harm, and deliver more personalized care.
At Memorial Medical Center, we have found that meaningful improvements in patient outcomes require continued investment in clinical pharmacy services, interdisciplinary collaboration, antimicrobial stewardship, medication optimization, pharmacogenomics, and evidence-based decision-making and are focusing on this value that pharmacy adds.
Healthcare leaders must invest not only in innovative technologies, but also in the pharmacy professionals, clinical infrastructure, and interdisciplinary partnerships required to ensure those technologies translate into safer and more effective patient care. The safest and most effective healthcare organizations will be those that embrace innovation while recognizing that patient safety ultimately depends on the people who transform information into action and personally I want to be part of that type of organization.
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