Pharmacy Quality Alliance (PQA)

Pharmacy Quality Alliance (PQA)

Definition: The Pharmacy Quality Alliance (PQA) is an independent, nonprofit national organization dedicated to improving medication safety, adherence, and appropriate use. A measure developer, researcher, educator and convener, PQA’s quality initiatives support better medication use and high-quality care.

The organization was established in 2006 as a public-private partnership with the Centers for Medicare and Medicaid Services (CMS) shortly after the implementation of the Medicare Part D Prescription Drug Benefit.^1,2 PQA promotes quality through several methods:²

• Development of quality measures
• Provision of quality-related education to members
• Conduct and promote research to identify new areas of quality measure development and to evaluate existing measures
• Convene stakeholders from a variety of disciplines for key issues discussions

How it relates to ACO/PCMH: ACOs and PCMHs seek to promote better quality patient care through care coordination and are rewarded for meeting quality metrics and decreasing patient care costs. PQA sets out to define how this quality of care is measured is what so that it can be evaluated across services.

PQA develops measures for health plans and pharmacies that can fall into one of three types of measures:³

• Performance measures are intended to evaluate the quality of health care processes, intermediate outcomes, or outcomes. These measures may be used in accountability programs such as public reporting, benchmarking, external comparisons, and performance payments.
• Monitoring measures are intended to promote standardized documentation and reporting of health care processes, intermediate outcomes, or outcomes. These measures may be used for standardized reporting requirements for monitoring or surveillance purposes but not for accountability programs.
• Quality improvement indicators (QIIs) are intended to assess the improvement of health care processes, intermediate outcomes, or outcomes from baseline within a population/organization. These measures may be used for self-assessment such as internal quality improvement, and do not require the use of standardized reporting.

PQAs pharmacy measures evaluate the quality of pharmacies and assess pharmacist-provided care and pharmacy-based services. Pharmacy performance measures will provide pharmacists the opportunity to demonstrate their contributions toward high-quality, patient-centered care and will include 20 PQA measures; 5 PQA endorsed pharmacy measures, 10 PQA pharmacy measure concepts in development, and 5 PQA pharmacy measure concepts prioritized for the future.³

PQA’s health plan measures are used in many value-based programs, including in the CMS Medicare Stars program. PQA has a relationship with CMS to help ensure the provision of quality services to Medicare beneficiaries. CMS creates plan ratings that indicate the quality of Medicare plans on a scale of 1 to 5 stars, with 5 stars being the highest rating. The overall star rating is determined through numerous performance measures across several domains, and these performance measure scores are combined at the domain and summary levels to provide an overall plan rating. Five PQA measures are included in the Medicare Part D Star Ratings for 2023: Medication Adherence for Diabetes Medications, Medication Adherence for Hypertension (RAS antagonists), Medication Adherence for Cholesterol (Statins), MTM Program Completion Rate for CMR, and Statin Use in Persons with Diabetes. Pharmacists and pharmacies can contribute to meeting these metrics, and may work directly with health plans in arrangements to do so.

Involved organizations/oversight: PQA is a collaboration of almost 250 different organizations, including but not limited to professional associations, universities and academic institutions, health technology and data analytics companies, health plans and pharmacy benefit managers, community pharmacies, foundations and research institutions, and government agencies. A complete list of PQA members can be found on their website.¹

Resources

1. Pharmacy Quality Alliance. About PQA. Alexandria, VA: Pharmacy Quality Alliance. Available at: https://www.pqaalliance.org/our-story. Accessed March 10, 2023.
2. Pharmacy Quality Alliance. The Pharmacy Quality Alliance: Optimizing health by advancing the quality of medication use. Alexandria, VA: Pharmacy Quality Alliance. Available at: https://pqa.memberclicks.net/assets/About/PQA_101.pdf. Accessed March 10, 2023.

3.     Pharmacy Quality Alliance. PQA measures overview. Alexandria, VA: Pharmacy Quality Alliance. Available at: https://www.pqaalliance.org/assets/Measures/PQA_Measures_Overview.pdf. Accessed March 10, 2023.

Contributing authors:

Jennifer Schaeffer, PharmD
PGY-1 Pharmacy Practice Resident
St. Luke’s University Health Network
Bethlehem, PA

Katura Bullock, PharmD, BCPS, BCACP
Clinical Integration Pharmacist
St. Luke’s University Health Network
Bethlehem, PA

Last Updated 3/12/2023