Transcript 1 The Pharmacy Quality Alliance

The Pharmacy Quality Alliance:
Promoting High-Value Health Care
via Transparency in Pharmacy Performance
Dave Domann, MS, R.Ph
Johnson & Johnson
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OBJECTIVES:
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Describe PQA’s mission and its stakeholders
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Discuss the status of PQA initiatives to develop and
test performance measures for pharmacies
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Delineate various uses of the PQA measures
Ensuring Quality in Healthcare
“The fundamental challenge in health care is
how to jump-start a new kind of competition –
competition on results in improving health
and serving patients.”
Redefining Health Care –
Michael Porter, Elizabeth Olmsted Teisberg
Porter ME, Teisberg EO, Redefining Health Care: Creating
Value-Based Competition on Results. Harvard Business
School Press, Boston Massachusetts, 2006.
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The Mission of the PQA is to:
Improve health care quality and patient safety
through a collaborative process in which key
stakeholders agree on a strategy for measuring
performance at the pharmacy and pharmacistlevels; collecting data in the least burdensome
way; and reporting meaningful information to
consumers, pharmacists, employers, health
insurance plans, and other healthcare decisionmakers to help make informed choices, improve
outcomes and stimulate the development of new
payment models.
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Who’s at the PQA Table?
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Pharmacy Quality Alliance (PQA)
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PQA was formed in April 2006
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CMS was instrumental in creation of PQA,
but does not control PQA
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Self-sustaining through dues of > 60 member
organizations
Steering Committee Organizations
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Agency for Healthcare Research and Quality (AHRQ)
The Brookings Institution
AARP
Academy of Managed Care Pharmacy (AMCP)
American Society of Consultant Pharmacists
America’s Health Insurance Plans (AHIP)
American Pharmacists Association (APhA)
Centers for Medicare & Medicaid Services, (CMS)
Express Scripts, Inc.
GlaxoSmithKline
National Alliance of State Pharmacy Associations
National Association of Chain Drug Stores (NACDS)
National Community Pharmacists Association (NCPA)
Pitney Bowes
Teva Pharmaceuticals USA
Pharmacy Quality Alliance’s Four
Primary Groups
Director
Director of Practice
Improvement
Quality Metrics
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Research
Coordinating Council
Data Aggregation
and Reporting
Education &
Communications
PQA Activities - 2006
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PQA formed in April 2006
From April through November 2006:
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Conducted environmental scan for existing measures of
pharmacy performance
Developed guidelines for public reports, and pharmacy
feedback reports, about pharmacy performance
Formed workgroups and cluster groups to develop measure
concepts
Endorsed 37 measure concepts
Developed plans for further development and testing of
measures
PQA Activities - 2007
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Contracted with NCQA and APC to develop
specifications for claims-based measures of
performance and pilot test the measures.
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Contracted with American Institutes for
Research (AIR) and UNC School of Pharmacy
to develop and pilot-test a questionnaire for
consumers (CAHPS-Pharmacy)
PQA’s Starter Set of Measures - 2007
1. Proportion of Days Covered: Beta Blockers
2. Proportion of Days Covered: (ACEI/ARB)
3. Proportion of Days Covered: Calcium Channel Blockers
4. Proportion of Days Covered: Dyslipidemia Medications
5. Proportion of Days Covered: Diabetes Meds (Sulphonylureas, Biguanides, TZDs)
6. Gap in Therapy: Beta Blockers
7. Gap in Therapy: (ACEI/ARB)
8. Gap in Therapy: Calcium Channel Blockers
9. Gap in Therapy: Dyslipidemia Medications
10. Gap in Therapy: Diabetes Medications (Sulphonylureas, Biguanides, TZDs)
11. Diabetes: Excessive Doses of Oral Medications
12. Diabetes: Suboptimal Treatment of Hypertension
13. Asthma: Suboptimal Control
14. Asthma: Absence of Controller Therapy
15. High‐Risk Medications in the Elderly
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PQA Adherence / Persistence Measures
Measure
Title
Measure Description/Definition
Gap in
Therapy
Percentage of prevalent users who experienced a
significant gap in medication therapy.
• A significant gap is defined as 30 days or greater
• Individual measures focus on a specific drug class
(e.g., beta blockers)
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Single Gap
Index Fill
Jan 15
90 day supply
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Refill Due
Actual Refill
Date
Apr 15
May 22
Single Gap
= 37 days
PQA Appropriateness Measure:
Suboptimal Treatment of HT in Diabetes
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Measure Title
Measure Description/Definition
Suboptimal treatment:
Diabetes
Percentage of patients dispensed
medications for diabetes and hypertension
who are not receiving an ACEI or ARB.
CAHPS Pharmacy Survey
 Consumer
 Assessment of
 Healthcare
 Providers and
 Systems
Developed by American
Institutes for Research –
University of North Carolina
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CAHPS results are used to
Assess the patientcenteredness and
quality of care from the
patient’s perspective,
Facilitate consumer
choice; and
Improve quality of care.
What’s Next for PQA ?
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Demonstration Projects
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Phase I 2008-09
Phase II 2009-11
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Selection of Generation II measures
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Educational programs for pharmacists, students, and other
stakeholders
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Participation in Quality Alliance Steering Committee (QASC)
Demonstration Projects
Phase I demonstration projects will focus on
determining:
 Resource requirements for aggregating data
 Generating pharmacy performance reports
 Gaining feedback about the reports from
pharmacy personnel
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Demonstration Projects
Four Project Areas
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Health Plan, or Prescription Drug Plan (PDP), generating
performance reports for its network of pharmacy providers
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A coalition of Health Plans, or PDPs, that work together to create
aggregate performance reports for pharmacies in a geographic
region
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Community pharmacy corporation that creates an internal
performance report system
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Other models for pharmacy performance report generation and
dissemination
PQA Demonstrations
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Call for Proposals was released early February
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17 brief proposals received
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10 invited to submit full proposals
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3-5 will be funded (final selection made in May)
PQA Demonstrations
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NCQA will provide technical assistance
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AHRQ will fund an “evaluation contractor”
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Phase I should be completed in mid-2009, and
Phase II should start soon after
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Phase II will focus on performance improvement
Cluster Groups - 2008
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Cardiovascular
Disorders
Consumer Feedback
and Assessment
Cost of Care
Diabetes
Respiratory Disorders
Medication Adherence
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Medication
Reconciliation
Mental Health
MTM Services
Patient Safety / eprescribing
Prevention and
Wellness
Educational Programs
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Educational Modules for Pharmacy School Curricula
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Continuing Education Programs for Pharmacists
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PQA Speakers Bureau to Communicate Pharmacy
Quality Measurement to Quality Improvement
Audiences
How will PQA measures be used?
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Potential Uses of PQA measures
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Quality/Performance Improvement
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Tested in Phase II demonstrations
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Public Reporting / Consumer Empowerment
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Contract & Network Decisions
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Pay for Performance (P4P)
Public Reports
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Information on hospital and physician quality is
increasingly available to the public.
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CMS may provide expanded performance
information on drug plan finder in 2008
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Drug plans, or regional coalitions, may start
providing pharmacy reports in near future.
Public reports could be embedded
in drug plan websites…
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PharmacyQuality.com
Pharmacy Performance:
What’s Your Grade?
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Compare Pharmacies
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Find My Pharmacy
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Network Decisions
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Pharmacies that score above a threshold of
quality could be included in a high
performance network for a health plan (with
higher payment for products / services)
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Pharmacies that consistently perform poorly
could be eliminated from the network (risk
adjustment will be crucial for this decision).
Will PQA lead us to P4P Models in
Pharmacy?
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In P4P, financial incentives are linked to quality
measures. Thus, potentially, pharmacies that score
higher on PQA measures could get a bonus or higher
dispensing fees, under a different financial model.
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Hospitals, physicians, and home health have all been
testing P4P models of payment, but the results have
been mixed. P4P appears to stimulate improvement in
some indicators but not all, and the long-term effect on
health outcomes is not yet known.
Pharmacy P4P Example:
Current Performance
Medication
Adherence
Medication
Safety
Appropriateness:
Asthma / Diabetes
# of patients
200
300
100
# Quality measures
7
3
4
Composite Quality
Score
60%
(120 adherent pts)
90%
93%
(270 pts meet criteria) (93 pts meet criteria)
Incentive
$ 10/pt
(for adherent pts)
$ 2/pt
$ 3/pt
Bonus Payment
$10 x 120 = $ 1,200
$4 x 270 = $ 1,080
$3 x 93 = $ 279
This example is presented for illustration only!
PQA has not endorsed any model for pharmacy P4P
Pharmacy P4P Example:
Improvement Model
Medication
Adherence
Medication
Safety
Appropriateness:
Asthma / Diabetes
# of patients
200
300
100
Score in 2006
60%
90%
93%
Score in 2007
70%
93%
92%
Incentive
$ 1/ pt / 1% increase
$ 0.50 / pt / 1% inc
$ 2 / pt / 1% increase
Bonus Payment
$1 x 200 x 10 =
$2000
$0.5 x 300 x 3 =
$ 450
$ 2 x 100 x 0 = $ 0
This example is presented for illustration only!
PQA has not endorsed any model for pharmacy P4P
Implications
“I don't fear pay for performance. I fear pay for
performance for measures that don't really
matter.”
Benjamin Brewer, MD
Wall Street Journal, January 29, 2008
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What are “quality” quality measures?
Who is responsible/accountable for the care?
Who is the quality “attributable” to?
 Physician, Nurse, Patient, Pharmacist, Health Plan, PBM?
Questions??....Always welcomed!
For more information:
www.pqaalliance.org
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