Loren Bonner
The shift to quality-based incentives continues to emerge in pharmacy. The Pharmacy Quality Alliance (PQA) is currently working to develop pharmacy measures for A1C and blood pressure reporting; adherence to medications for hypertension, high cholesterol, and diabetes treatment; and antidepressant medication management.
These are important measures that address chronic, high-cost, and high-burden diseases, PQA noted.
According to Lynn Pezzullo, RPh, senior director of quality innovation at PQA, there’s a strong interest in these measures not only from payers, but also because pharmacists are able to directly improve their patients’ health in these areas.
The measures, once completed, will be appropriate to use in value-based plan pharmacy agreements.
PQA’s work on these new measures began in 2020, a continuation of work on pharmacy measures that started in 2019. Their efforts were in response to interest from members and policymakers who wanted to better evaluate pharmacy quality as well as assess pharmacist-provided care and pharmacy-based services. “Multistakeholder groups have helped in the prioritization and development of these measures,” said
Pezzullo.
Use beyond Medicare Part D
Moving to an outcomes-based system of care means developing clinical measures to assess whether patients are meeting specified clinical goals.
PQA got its start in 2006 developing performance measures that center on addressing the appropriate and safe use of medications. The work began with measures for the Medicare Part D prescription drug program.
Within Medicare Part D, the Medicare star ratings program awards quality bonus payments within the Medicare Advantage program on the basis of how well health plans execute a set of performance measures. Five PQA measures are included in the Medicare Part D star ratings program.
However, PQA measures are beginning to be used in other sectors, including state-based and private sector programs. Overall, 15 PQA measures are used across CMS’ quality programs and more are used in state and regional quality programs. “Our measures we develop can be used beyond Medicare Part D,” said Pezzullo. This is especially true as more pharmacists move away from dispensing and toward providing patient care services.
Even so, the new PQA pharmacy measures in development align with CMS’s star ratings program as well as CMS’s Healthcare Effectiveness data and Information Set (HEDIS) measures, which are a set of standardized performance measures that provide purchasers and consumers with information to compare health plan performance.
Shift to value-based care
PQA’s foundational measures rely on prescription claims data. But in the shift to value-based care, the performance measures being developed by PQA are based on pharmacy data that expand beyond dispensing and claims data.
“Health plans recognize that pharmacists improve patients’ outcomes,” said Pezzullo. For example, pharmacists can close gaps in care by administering appropriate immunizations to patients and improve clinical measures such as A1C levels.
“Improving patients’ health outcomes is a goal for all stakeholders across health care,” Pezzullo said.
PQA aims to complete development of these pharmacy measures and have them available for use by early 2022 and 2023.
There are three types of PQA measures:
- Performance measures
- Monitoring measures
- Quality improvement indicators
Only PQA performance measures can be used in accountability programs and only for the intended level of attribution.
PQA measures are grouped into four domains:
- Adherence
- Appropriate medication use
- Medication safety
- Medication management services
PQA has two measure sets focused on opioids and specialty medications. Most PQA measures are for evaluating health plan performance and quality improvement. PQA also has a set of pharmacy measures for evaluating pharmacy performance and quality improvement.