RAPID Alliance

Medications 360 Study

Using new science (service dominant logic and service ecosystem design science) to save millions of lives and up to $528 billion in annual spending in the US by co-creating and implementing the RAPID Alliance Medications 360 Strategic Framework 2022 - 2031, RAPID Funding Portfolio, RAPID Solutions Network and Other Shared Resources.

Phase 1. Plan | Phase 2. Implement

A RAPID Alliance / STAR Study Initiative in the National Science Foundation Center for Health Organization Transformation at the University of Louisville in collaboration with the Frazier Polypharmacy Program at the University of Louisville, an NSF CHOT industry partner, and many other partners.


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Please join our nationwide network of leading universities in this important national initiative

Together we will co-create and implement the

RAPID Alliance Medications 360 Strategic Framework 2022 - 2031

supported by a set of shared resources including the

RAPID Funding Portfolio | RAPID Solutions Network

RAPID Learning Centers | RAPID Innovation Labs

These resources will empower all stakeholders in the US medication and vaccine delivery ecosystem to work together, more effectively, at ecosystem-scale, supported by high quality research and evidence, to accelerate the nation's ability to optimize medication and vaccine use in the next decade.

Who Is Involved?

(click to see details)

University Research Partners

A growing network of leading US research universities, academic medical centers and schools of pharmacy includingAmerican University of Health Sciences | Belmont University | Binghamton University | California Northstate University | Chapman University | Ferris State University | Howard University | Lipscomb University | Loma Linda University | Long Island University | Marshall University | Medical College Wisconsin | Mercer University | North Dakota State | Oregon Health & Science University | Oregon State University | South Dakota State University | Sullivan University | Temple University | University of Arkansas | University of Cincinnati | University of Colorado | University of Georgia | University of Hawaii Hilo | University of Houston | University of Kentucky | University of Louisville | University of Michigan | University of Mississippi | University of Nebraska | University of Nevada Reno | University of Pittsburgh | University of Rhode Island | University of South Carolina | University of Tennessee | Washington State University, Wayne State University, Western University.

RAPID Alliance Practice Council Members

A growing network of US organizations, associations, government leaders, foundations, and others interested in optimizing medications and vaccines for US populations includingPatient Advocate Foundation (PAF) | American Pharmacists Association (APhA) | American Society of Health-System Pharmacists (ASHP) | Academy of Managed Care Pharmacy (AMCP) | American Society of Consultant Pharmacists (ASCP) | American Association of Colleges of Pharmacy (AACP) | National Alliance of State Pharmacy Associations (NASPA) | National Association of Chain Drug Stores (NACDS) | National Community Pharmacies Association (NCPA) | The Community Pharmacy Foundation | CPESN USA | Sanofi and Sanofi Pasteur

RAPID Alliance Funding Partners

Community Pharmacy Foundation | Sanofi and Sanofi Pasteur Frazier Polypharmacy Program at the University of Louisville | National Science Foundation Center for Health Organization Transformation

RAPID Alliance Councils

RAPID Alliance Practice Council Individual Members | RAPID Alliance Research Council Individual Members

RAPID Alliance Workgroups

RAPID Alliance Medications 360 Steering Workgroup Member

Co-Creation Calendar - Save the Dates

All-Hands-on-Deck Strategic Plan Co-Creation Meeting #1: Welcome, Getting Organized

October 28, 2021, 1:00 – 2:30 pm. Register

All-Hands-on-Deck Co-Creation Meeting # 2: Study Section and Breakout Group Assignments

December 1, 2021, 1:00 – 2:30 pm. Register

All-Hands-on-Deck Co-Creation Meeting #3

January TBD

All-Hands-on-Deck Co-Creation Meeting #4

February TBD

All-Hands-on-Deck Co-Creation Meeting # 5


National Summit


April 11-15, 2022 (tentative)

Call to Action

We - a growing group of researchers, leaders and experts from the US medications and vaccines space - are honored to extend an invitation to you and others in your university, organization, association, foundation, and/or government agency to join us in a large-scale action-research study to address one of the most significant public health challenges in the US - non-optimized medication and vaccine use. This will set the stage for advancing knowledge about how to address other "ecosystem-level" challenges in society.

Call to University Leaders, Deans, Chairs and Researchers

If you are a university-based research leader, dean, chair or researcher with an interest in conducting research to: a.) improve delivery of medications and vaccines to US populations and/or b.) advance generalizable knowledge about how to develop and spread transformational innovations for improving health in society, you are invited to join as a University Research Partner. International researchers with an interest in sharing knowledge across national contexts are also welcome to join. Benefits of joining include a seat at the table in helping develop a national research and action agenda, new opportunities for funded research in your areas of specialty, and learning and growth opportunities for faculty and students.

Join as a University Research Partner

Call To CEOs, Senior Leaders and Directors of National and State Organizations, Associations, Foundations and Government Agencies

If you are a CEO, senior leader, or agency director leading an organization, association, foundation, government agency or other group with a strategic interest in improving delivery of medications and vaccines to US populations, at national or state levels, you are invited to join as a Strategic Action Partner. As a strategic action partner, you will be able to designate key leaders, experts, innovators and early stage career people in your organization to participate in the study. Benefits include a seat at the table in helping develop a national research and action agenda to address this challenge, early identification of new strategic opportunities for action in your areas of specialty, and career development opportunities for your team members.

Join as a Strategic Action Partner

Call to Funding Partners

If you are a leader from a foundation, philanthropic organization, government agency, individual, or other entity that is interested in funding research and action to help protect and improve health and wellbeing of US populations you are invited to join as a Funding Partner. Your contributions will help support this important work.

Join as a Funding Partner

Call to Individual Leaders, Experts, Scholars and Innovators Who Are Passionate About Optimizing Medication and Vaccine Use for US Populations

If you are a leader, expert, scholar, innovator or student operating at a local, state, national or international level who is passionate about optimizing medication and vaccine use for US populations, you are invited to join as an Individual Participant. Individual participants will have a seat at the table in co-creating and implementing a new strategic research and action agenda, and gain many opportunities to learn, connect, support, innovate and co-create.

Join as an Individual Participant

Why is this Important?

The COVID-19 pandemic has highlighted an urgent need to better understand how transformational health innovations (e.g. tests, vaccines, medications and services for large populations of people) can be more rapidly developed, distributed and delivered to protect and strengthen population health. Non-optimized medication use (e.g. adverse drug events and other challenges) is associated with millions of likely-avoidable illnesses and deaths annually while costing an estimated $528 billion per year for likely-avoidable hospitalizations, emergencies and physician visits. The medications and vaccines challenge is an example of a new class of ecosystem-level health challenges which requires new kinds of research and action to address.

What's New and Unique?

What makes this study unique is the use of new science (service-dominant logic and service ecosystem design science), and advanced collaboration tools and technologies to accelerate ecosystem-level change for the US medications space.

How Will It Work?

This project will have two phases. Phase 1 is to co-create an all-stakeholder, evidence-based, ecosystem-level strategic framework and plan and prioritized national research agenda 2022 - 2031. The Phase 2 goal, beginning in April 2022, is to implement the plan.

Multiple Ways to Engage

There are multiple ways to engage. You can join as an observer, participant, or in more active roles. The research platform may also be extended to help address other system challenges to health - including, for instance, coordinating research and action to address climate change risks, health equity related risks, or digital misinformation related risks. Finally, we also invite you to join us in co-creating a new Society and Journal of Health Ecosystem Research and Innovation (SHERI and JHERI) to support this work.

Benefits for Individual Participants

Learn | Access | Contribute | Connect | Innovate | Study

Learn more about the New Science of Service-Dominant Logic and Service Ecosystem Design Science and its implications for helping you and your teams, organizations and communities improve care for those you serve.

Gain access to current best practices and emerging innovations for delivering person-centered care in today's rapidly changing environment

Know that you played a part in co-creating an ecosystem-level strategic plan and national research agenda for optimizing medication and vaccine use for the US population for the next decade

Strengthen connections with other leaders, experts and scholars

Identify new strategic opportunities for you, your teams and organizations

Researchers: New opportunities to advance research interests.

Study Goals

Together, we will co-create an all-stakeholder, evidence-based ecosystem-level strategic framework and plan and prioritized national research agenda for optimizing medications and vaccines for US populations from 2022 - 2031 while saving up to $528 billion per year. We will then work, together, to implement the plan.

In addition, the research community will co-create health ecosystem change theory and conduct ecosystem analytics to advance generalizable knowledge about how to speed up development and spread of transformational innovations of many kinds in order to protect and improve health in society at scale.

Study Deliverables (Phase 1)

US Medications Ecosystem Strategic Framework (2022 - 2031)

How Do We Move Forward?

Research Regatta Method

(A Virtualized Nominal Group Technique Tournament)
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Ready to Get Started?

Participating is quick and easy. Work at your own pace using a step by step instruction guide.

Quick Links

Additional Background Information

Problem Being Addressed

The problem the Medications 360 study is addressing is the high rate of non-optimized medication therapies and adverse drug events affecting US populations. This is one of the most significant challenges in US healthcare today. It affects millions of people annually and costs an estimated $528 billion per year for likely-preventable hospitalizations, emergencies, and doctor visits. The challenge has, in many ways, gotten worse during the COVID-19 Pandemic.

  1. Includes prescription medications, vaccines, pharmacogenomics, over-the-counter medications, nutraceuticals, digital therapeutics, patient education and support
  2. Cost of Prescription Drug-Related Morbidity and Mortality, J. H. Watanabe, T. McInnis and J. D. Hirsch, Annals of Pharmacotherapy 2018 Vol. 52 Issue 9 Pages 829-837
  3. National Action Plan for Adverse Drug Event Prevention, 2019 (https://health.gov/sites/default/files/2019-09/ADE-Action-Plan-Introduction.pdf)

The RAPID Alliance Medications 360 study, and its "parent" study, the RAPID Alliance / STAR Study were developed based on findings from the RAPID Alliance Study conducted in 2020 during the COVID-19 pandemic. The RAPID Alliance Study identified four transformational strategies that, combined, offer potential to drive transformational improvements in medications use for US populations. The Medications 360 study supports the fourth strategy: "develop a national "big tent" research consortium. The RAPID Alliance / STAR Study provides a broad research contexts for this and other studies.

The study design was developed with input from nationally recognized leaders and scholars serving on the RAPID Alliance Practice Council and Research Council (view here), as well as leaders and scholars in the National Science Foundation Center for Health Organization Transformation.

Four Transformational Strategies

Report Infographic

(the 2021 report at a glance)

The "Fragmentation" Challenge

Fragmentation in the medication ecosystem is a major barrier to change

An underlying factor contributing to the US medications challenge - as described in the RAPID Alliance 2021 Study - is fragmentation. The medications delivery ecosystem is highly fragmented at national and state levels with many silos operating out of sync with others. Patient advocates, physicians and clinicians, pharmacists and pharmacies, pharmaceutical firms, health plans and PBMs, plan sponsors, standards organizations, technology organizations, government agencies and policymakers tend to operate in many different silos. In addition, medication practice is often siloed based on different disease states being served. The fragmentation problem raises a key question.

What can be done to reduce medication sector fragmentation, in order to optimize medication use for US populations?

Overcoming Fragmentation

The New Science of Service-Dominant Logic and Service Ecosystem Design

It's all about "Co-Creation"

  1. Why does it Matter?

Service-dominant logic (SDL) and service ecosystem design science are critical for stakeholders in this project to understand. Past efforts to impact large systemic healthcare change and improvements have been hampered by approaches that exclude SDL, because they failed to address the service-ecosystem as a whole, and did not focus on co-creation at scale as a guiding principle for change in the ecosystem. As healthcare delivery becomes increasing interconnected, it is critical for the healthcare sector to understand this new area of science emerging out of the business and economics disciplines.

2. What is Service-Dominant Logic?

As the "service economy" continues to expand, researchers have been working to better understanding the nature of services in society . Service-Dominant Logic is a way of understanding how both human and technological services work. Service-Dominant Logic builds from five axioms presented in a seminal paper by Stephen L Vargo et al (access here):

1. Service is the fundamental basis of exchange in society (not products)

2. Value is co-created by multiple actors, always including the beneficiary

3. All social and economic actors are resource integrators

4. Value is always uniquely and phenomenologically determined by the beneficiary

5. Value co-creation is coordinated through actor-generated institutions and institutional arrangements

In this view, "co-creation" is the fundamental logic guiding how services work.

3. What is Product-Dominant Logic?

Product-Dominant Logic is the logic of how products work. In this logic, efficient production, distribution and consumption of products is a key consideration. Typically, producers and consumers are distinct and different, unlike in in service co-creation, where roles can shift and change fluidly.

4. What are Service Ecosystems?

    • Service ecosystems are sets of interconnected actors, artifacts and institutions in society. Actors are individuals, organizations or networks involved in exchanging artifacts; artifacts are information, products, services and other items that are exchanged among actors; and institutions are rules, laws and customs and the entities that oversee them, that guide how entities exchange artifacts in society.

5. What is Design Science?

Design science is a discipline that originated in the engineering and information technology fields. It considers how to design technology systems to optimize for a desired outcome. A typical design science question might be: what is the optimal engineering design to achieve a sub-second response time in a search engine system processing 1 million search transactions a minute. Researchers formulate design hypotheses, which can then be tested though models, simulation, pilot tests, and in the field. This approach can be applied to many other fields - including service ecosystem design.

6. What is Service Ecosystem Design Science?

Service ecosystem design science explores measurable attributes of a service ecosystem (such as the US medications ecosystem), and generates evidence-based hypotheses about ways to change those attributes in order to to achieve a desired outcome (e.g. reduce adverse drug events or increase population health and wellbeing measures). These hypotheses can then be tested through modeling, simulations, pilots, comparative studies, and evaluation of existing programs.

7. How Does Service Ecosystem Design Science Interact with Other Disciplines?

Service ecosystem design science is, inherently, a multi-disciplinary field. Other important areas of science related to it include implementation science, collaboration science and other related areas of science: Service ecosystem design science works hand-in-glove with other areas of science, including, importantly, implementation science, population health sciences, health sciences, information systems engineering, social sciences, and social network sciences.

Why Now?

What we've been doing isn't working | COVID-19 pandemic | Collaboration tools and methods

The health profession sector has attempted to address the problem, but with little success for the past 30 years. The RAPID Alliance 2021 Report identified a probable reason: the need to co-create solutions using a whole ecosystem all-stakeholder approach. This is now feasible using available collaboration tools and methods, supported by service-dominant logic and service ecosystem design science approaches.

Also, as the saying goes, you should never waste a good crisis. The COVID-19 pandemic has increased many peoples' awareness of the value pharmacists and pharmacies provide in healthcare. The need to do more to encourage people to optimize their medication and vaccine use has never been stronger.

New Science | New Technologies

Service-Dominant Logic | Service Ecosystem Design Science | Collaboration Tools and Technologies

This study is breaking new ground by using service-dominant logic, service-ecosystem design science, and a method for conducting large scale action research collaborations called a "Research Regatta" to develop transformational strategies and a priority research agenda for an entire national ecosystem and the 50 states within it.

Service ecosystem design science, supported by service-dominant logic, is an emerging field of research looking at how entire social ecosystems operate. Service ecosystems are defined as sets of entities (individuals, organizations, networks), artifacts (information, products, services) and institutions (rules, customs and governing bodies), involved in co-creating value for people in the ecosystem.

A Regatta Regatta is a way to bring thousands of leaders, experts and scholars from across a service ecosystem together, to co-create answers to questions. The method can support simultaneous planning processes by hundreds, or thousands of people. It works by organizing people into hundreds of expert panels of 7-15 leaders, experts and scholars each. Each panel uses nominal group technique to develop ranked answers to questions. Trusted university scholars and researchers are embedded in each panel to provide facilitation, evidence, and guidance and to help analyze data to develop the plan.

To avoid "funding bias", a collaborative funding model is used. While funding is not required to participate, each participating organization, association and government agencies involved is encouraged to make a contribution to support the study. Funds are used to pay researchers at many universities to help facilitate the effort.

The study is being led by a research team in the National Science Foundation Center for Health Organization Transformation at the University of Louisville under a 5-year study IRB, designed to support inclusion of researchers from many different universities.

Nature of Study

Large Scale Collaborative Study | IRB Approved 5 Year Study

See www.starstudy.link

IRB Approved Protocol

While the study has similarities to a "strategic planning" process, it is organized as a research study. This allows a more rigorous approach to be used for operating the study. The method includes carefully defined participant inclusion criteria, registration system, and protection of privacy, confidentially and human subjects under an approved IRB protocol.

Research Regatta

A research regatta methodology is used to actually organize participants from across the US, and all 50 states, in expert panels of 7-15 people each. These are called "boats." Each expert panel uses nominal group technique to brainstorm answers to the research questions. Details about this approach are in the FAQs.

Research Questions

What are the Strategic Priorities for the US Medications Ecosystem 2022 - 2030?

Patient Needs? | Barriers? | Strategies? | Research Priorities ?

What Factors Affect Spread of Transformational Innovations in Ecosystems?

What ecosystem factors can be measured? What are their effects on the development and spread of transformational health innovations including COVID-19 tests and vaccines, other vaccines, comprehensive medication management services and other services for US populations?

What services do patients need most related to medications? Which patient segments need those services?

What key barriers are limiting patients from getting these services?

What evidence-based strategies – ones that can be supported by a critical mass of key stakeholders – are most likely to accelerate ability to reduce adverse drug events and other non-optimized medication therapies in the US from 2022 to 2032?

What priority research is needed to support implementation of these strategies?

What Do Ecosystem Analytics Say About How to Move Forward at Ecosystem-Scale? What factors can be changed to speed up innovation?

Theory and Methods

Health Ecosystem Change Theory 1.0, developed by the research team based on prior research, is being used to guide the study. The theory will be refined as more data and analysis is conducted. It is designed to generate a new class of ecosystem analytics. A Virtualized Nominal Group Technique Tournament (a "Research Regatta") will be used to bring everyone together at scale to co-create a strategic framework, plan and research priorities. Many researchers, from many universities and disciplines, will help co-create and analyze these ecosystem analytics, over time, to help guide ecosystem-level change in support of priority strategies. Researchers who join as co-investigators will have access to selected ecosystem analytics data under the IRB protocol.

Who is Invited?

(Select a category to see details)

University Research Partners

(National and All 50 States)

Scholars, leaders, staff and students from the following disciplines are included in the selection criteria

University Research Leadership

University-Wide Research Leadership

Academic Medical Center Research Leadership

Schools and Departments



Nursing and Other Allied Health Professions

Public Health

Business / Health Economics

Social work

Psychiatry / Psychology

Engineering (Health Information Systems and Technologies)

Law, Ethics, Justice, Equity

Other relevant disciplines

Learn More


What is a Research Regatta?

Overview of Method

A Research Regatta is a method for enabling leaders and researchers from multiple sectors and disciplines to "row together" to achieve a shared goal in society. It is grounded in the principles of service ecosystem design science, service-dominant logic, and collaboration sciences.

In a Research Regatta, people are organized into virtual panels call "boats," with 7-15 people in each. Boats are organized to race in "study sections". These may include stakeholder sections (e.g. pharmacists, physicians, health plans, mixed crews and so on) and functional sections (e.g. services and operations, payment and finance, technology, policy, measures, and so on). Each boat uses nominal group technique to brainstorm, refine and vote to develop consensus solutions to problems. Answers are refined by multiple crews working together over several rounds.

The anticipated results are broadly supported, actionable strategies and directions for developing and implementing enhanced infrastructure designed to improve the health of people in society.

Learn more in the Study Design section.

How Much Time Does Participation Take?

Time Commitments

In this study, there are four levels of participation with different levels of time commitment required:

  1. Observers can observe and comment at any time and provide input to participants they are supporting. There is no time commitment.

  2. Voting Participants should plan to spend about 2 hours a month on a flex-schedule during the Regatta process. Most work is "on your own time" providing input into collaborative documents and forms. There may be 30-60 minute team/zoom calls as well. Activities will include learning (by viewing introductory videos), sharing ideas in collaborative documents, voting on top ideas, attending summit meetings, and completing brief surveys.

  3. Facilitators are people helping facilitate "boats" with 7-15 people. Facilitators should plan to spend 2-4 hours per month flex time.

  4. Co-Investigators / Research Assistants inputs are based on the situation. Time commitments can range from 1-2 hours a month for helping curate a collection in the learning center, to significant time in a formal role as a co-investigator.

What are Ecosystem Analytics?

Ecosystem analysis is a way to model network structures, processes and dynamics across ecosystems involving many actors (people, organizations, institutions), artifacts (products, services and technologies) and institutions (local, state, national and international policymakers, standards groups, universities and other institutional leaders). We plan to use new "ecosystem analytics" tools and technologies to begin to map the US medications "service ecosystem", to better understand factors including:

  • Fragmentation Levels (predicted to limit ability to come together to plan and implement change)

  • Trust Barriers (predicted to limit ability to coordinate change)

  • Resource Sharing Barriers (predicted to limit ability to fund change)

  • Knowledge Sharing Barriers (predicted to limit ability to understand and explain the reasons for change)

  • Information Technology Fragmentation Barriers (predicted to limit ability to access and analyze data, information and analytics needed to guide change)

Ecosystem analytics will help generate evidence-based recommendations for reducing gaps in order to accelerate progress.

Innovative Collaborative Funding Model

To avoid funding bias, a collaborative research funding model is used. Each participating strategic action partner is asked to contribute, if possible, to support the overall effort. In return, contributors will receive valuable benefits including recognition on the website, summit and in reports. In addition, funding partners are asked to provide large funding to support the overall study and study section activities. All funds support researchers at participating universities.

Please consider contributing at one of following levels:

  • Underwriter: $50,000+

  • Anchor Contributor: $25,000

  • Strategic Contributor: $10,000

  • Executive Contributor: $5,000

  • Annual Membership in the RAPID Alliance: $50,000+ per year

  • Funding Partner: $50,000+

Founding Investigators

Judah Thornewill, PhD

Principal Investigator

Assistant Professor and Executive in Residence, University of Louisville, School of Public Health and Information Sciences, Department of Health Management and Systems Science. Investigator with NSF CHOT at UofL.

Demetra Antimisiaris, PharmD, BCGP, FASCP


Associate Professor, Director, University of Louisville Frazier Polypharmacy and Medication Management Program, School of Public Health and Information Sciences, Department of Health Management and Systems Sciences, Investigator, NSF CHOT at UofL.

Robert Esterhay, MD


Associate Professor and Chair Emeritus, University of Louisville, School of Public Health and Information Sciences, Department of Health Management and Systems Sciences. Investigator, NSF CHOT at UofL. Health and population health informatics.

Emmanuel Ezekekwu, PhD(c)

Graduate Research Assistant (GRA)

PhD Candidate at the University of Louisville, School of Public Health and Information Sciences, Department of Health Management and Systems; Research Assistant at NSF CHOT at UofL

Tom Walton, MDiv, MS


Executive in Residence, University of Louisville, School of Public Health and Information Sciences, Department of Health Management and Systems Science. Modeling.

William Yasnoff, MD, PhD, FACMI


Adjunct Professor, Health Sciences Informatics, Johns Hopkins University; Managing Partner, National Health Information Infrastructure (NHII) Advisors; Former Senior Advisor, NHII, U.S. Dept. of Health and Human Services; Former Member, Board on Population Health and Public Health Practice, National Academy of Medicine.

Thank You

Thank you to our RAPID Alliance 2021 Practice Council and Research Council Members and others for their contributions in co-creating this study.

Thank you to our Practice Council members for their vision of co-creating a national research infrastructure designed to support strategic action with potential to make a transformational difference. Thank you to selected Research Council members for guidance to help strengthen the study design.

Leadership Provided by our Practice and Research Council Members including