The following column is written by Micah Cost, the Chief Executive Officer of the Pharmacy Quality Alliance (PQA). As a seasoned healthcare association executive, Cost leads a dedicated team of professionals and works in collaboration with approximately 250 member organizations to achieve PQA’s mission and promote high-quality medication safety, adherence, and appropriate use through measurement, research, education, and convening.
The Pharmacy Quality Alliance (PQA) continues with our work to develop a set of standard pharmacy performance measures that would be appropriate for use in value-based plan-pharmacy agreements.
The vision for PQA was to usher in a quality-focused framework to support a new pharmacy payment system focused on enhancing value within the healthcare system. Developing pharmacy performance measures directly aligns with that vision. It wasn’t until recently that pharmacy practice and our healthcare system were ready to realize this vision.
Today’s effort is responsive to requests from our members, as well as proposed rules from the Centers for Medicare and Medicaid Services (CMS) and proposed federal legislation, all of which have signaled growing interest in pharmacy performance measures. Further, PQA believes that pharmacy performance measures can support greater patient access to care and services through team-based care and to facilitate value-based contracts between pharmacists and payers.
Shift to Value-based
Although patients view pharmacists as some of their most trusted healthcare allies, the pharmacy profession continues to seek a more meaningful model of care that displays their value as providers to payers, health plans, and fellow providers. The gradual progression of our health care system away from the traditional fee-for-service model and toward a more performance-driven and value-based care framework, both in public payer programs such as Medicare and Medicaid, as well as patient-centered medical homes and accountable care organizations, presents the pharmacy profession with a great opportunity to do just that.
This shift to pay-for-value programs has shown the importance of performance measurement in monitoring and improving the quality of care in a variety of patient care settings, such as hospitals, long-term care facilities, medical group practices, and other settings. However, a standardized performance program for pharmacy practice does not currently exist, which reflects the product-based reimbursement infrastructure that continues to confine pharmacists.
With the focus now more narrowed on increasing value, pharmacists have an opportunity to play a more direct and measurable role in the delivery of patient care services.
Pharmacy Performance Measures
It’s important to note that pharmacy measures are different than, but can be complimentary to, other performance measurement programs for physicians and other providers, especially in relation to medication-related outcomes of care. Pharmacy measures are also a tangible mechanism that can aid in quantifying the clinical and fiscal impact of pharmacist-provided care to payers and health plans.
Medication adherence is a prime example of the ability to leverage pharmacy performance measures to support value-based contracts between payers and pharmacies. For instance, CMS, in its 2021 national impact assessment report, identified that improving medication adherence for PQA’s three primary proportion of days covered (PDC) measures resulted in $46.6 billion in estimated healthcare costs avoided. PDC is the preferred method to measure medication adherence.
How can pharmacy performance measures evaluating clinical endpoints and biomarkers further drive home quality of care? Our initial prioritized pharmacy performance measure set will focus on services that pharmacists can most impact on a broad scale, such as hemoglobin A1C, blood pressure, immunizations, and a PDC composite adherence measure.
Five PQA pharmacy measures are ready to use now. Four of them are focused on adherence, and a fifth addresses Specialty Pharmacy Turnaround Time. We also have underway two proof-of-concept pilots to implement four promising blood pressure and hemoglobin A1C pharmacy measure concepts in value-based payment arrangements (VBAs) between payers and pharmacies. We are seeking funding partners to help us study feasibility issues for our immunization measure concepts.
Pharmacy performance measures, which incorporate clinical biometrics such as hemoglobin A1C and blood pressure, and guideline-based preventive care interventions such as immunizations, support the delivery of clinical care and services by pharmacists and provide essential health information to plans, payers, and providers.
There are other factors that must be addressed to ensure the success of this effort. The pharmacy profession must continue its pursuit of a re-envisioned practice environment that supports pharmacist-provided care. The physical pharmacy practice setting must be patient-focused and supportive of pharmacists as providers.
Practice models must ensure that pharmacists and pharmacy personnel are empowered to practice at the top of their training. Organizations must continue to push for the inclusion of pharmacists as members in team-based care. The first step is aligning incentives and laying the path forward, and PQA is committed to playing its part by developing pharmacy performance measures.
As the stars continue to align, pharmacists will have an opportunity to establish their role as providers in the value-based care environment of the future. PQA remains committed to working alongside our forward-thinking members and diverse stakeholders to finish the job we started on pharmacy performance measures.
- Micah Cost, PharmD, MS, CAE