Experts Predict Increasing Importance of Quality Measures, Team-Based Care in the Future of Pharmacy

Developing consensus-based quality measures and integrating pharmacists into care teams will be increasingly important for pharmacists in the coming decade, said a panel of experts during a town hall discussion at the Pharmacy Quality Alliance (PQA) 2021 Annual Meeting.

PQA CEO Micah Cost, PharmD, MS, spoke with PQA founders Mark McClellan, MD, PhD, and Larry Kocot, JD, about the past 15 years of the alliance and what they predict for the future. Cost said PQA was formed around the idea that pharmacists have a direct influence on value-based care through their connections with patients and their medication optimization expertise.

“When they established PQA, Mark said, ‘The launch of PQA is an important step toward a pharmacy business model that reports real value delivered, rather than just the volume of prescriptions dispensed,’” Cost said during the town hall. “It was a visionary declaration recognizing the direct influence of medication optimization on value-based care.”

Pharmacy quality improvements are a vital part of demonstrating the value of pharmacists, Kocot said, emphasizing that demonstrating, measuring, and quantifying pharmacists’ value is essential to moving to the forefront of the health care field. Furthermore, he said finding ways to get paid for these services is an important issue to watch in the future. Pushing for payments has been a challenge over the past 15 years since PQA was founded, Kocot said, and although it has been disappointing at times, he said the progress has been encouraging.

“When we started, pharmacists weren’t exactly happy with where they were with plan reimbursements. [Medication therapy management], remember, was the promise for pharmacy’s future and it didn’t really turn out to be as much as what pharmacists really thought it was going to be,” Kocot said. “So, you know…it wasn’t all roses, to be honest with you. There was a lot more expectation of being compensated for the value that [pharmacists] delivered.”

Contributing to quality measurements is an important way to quantify this value, Kocot said. He pointed to the Roadmap for HIT Integration, which has measures leveraging pharmacists to optimize medication therapy; to resolve polypharmacy issues; to assess patient data and reported outcomes; and to assess social determinants of health. He challenged PQA and pharmacists more broadly to step out of their comfort zones and find new, novel ways to provide care and demonstrate value.

McClellan agreed, and added that the core measurements and quality improvement focus areas of PQA are still relevant. With greater access to data and increasing digitization of health care, however, he said pharmacists have a great opportunity to reach new heights.

“What still matters is are patients on the right medications, are their medications managed effectively, and [do] they understand them, are they adhering effectively, and most importantly, do they get the best outcomes at the lowest cost?” McClellan said.

He added that pharmacists have seen incredible opportunities to demonstrate their value during the COVID-19 pandemic. For example, rather than viewing telehealth as a single connection to a physician via video, McClellan said it can consist of a whole set of virtual services from a team of providers, including pharmacists. Similarly, pharmacists have leveraged their position as trusted, accessible community-members in order to vaccinate as many people as possible, illustrating their direct value to the health care system.

McClellan and Kocot next turned to a discussion of social determinants of health, which McClellan noted has been particularly relevant during the COVID-19 vaccine campaign. He noted that it is a major focus for state Medicare programs, as well as federal policy leaders, and priorities include areas such as food insecurity, housing access, and anything else that can limit patients’ ability to receive and take their medications as prescribed.

“As we’re seeing more data systems and more supports built out around connecting people to support that can address those issues, I see pharmacists being quite important, as like that front-line health care provider that can potentially help with addressing those social drivers of health that have so much of an impact on being able to afford and use medications effectively,” McClellan said.

Kocot added that none of this is new for pharmacists, who have been working with patients to determine their needs for more than a century. Leveraging pharmacists’ connections with patients and capturing it as data will be especially important as pharmacists seek provider status and payment for their services, he said.

Finally, Kocot and McClellan both said they predict an exciting future for PQA and the pharmacy field. Kocot said he anticipates that performance measurement will improve and be more refined as it impacts quality improvement and added that strong leadership is essential.

“That opportunity to be a provider has to be more important than just being called a provider for pharmacists,” Kocot said. “You have to jump in, as Mark said, with team-based care [and] with value-based care and really do what pharmacists have been trained to do.”

McClellan said he predicts a growing interest in demonstrating that quality improvement measures directly lead to improved outcomes and lower costs for both patients and the health care system. He noted that there are increasing efforts to get consensus-aligned measures in other areas, such as primary and specialty care, so pharmacy must embrace these changes in order to move into the future.

“If you embrace this, this future is with you,” McClellan concluded. “People want care that’s more convenient. There’s going to be better ways for pharmacists to work with clinicians, with other parts of the care team more easily using digital technologies and [artificial intelligence], and other tools.”

REFERENCE

Cost M, Kocot L, McClellan M. Town Hall. Presented at: Pharmacy Quality Alliance 2021 Annual Meeting; May 11, 2021. Accessed May 11, 2021.