Implementing Pharmacy Performance Measures for Value-Based Care

The Pharmacy Quality Alliance (PQA) has a new pharmacy performance measure that evaluates adherence to medications for diabetes, hypertension (renin angiotensin system antagonists) and high cholesterol (statins), through a single composite measure.¹

You may be thinking, “I thought PQA already had member-endorsed adherence measures for these medications.” The answer is a bit nuanced.

There are 3 similar PQA adherence measures used in the Medicare Part D Star Ratings that were specifically developed, tested and specified for health plan performance measurement.² There are notable differences between those health plan measures and our new pharmacy measure.

Endorsed by PQA members in December after a rigorous development and testing process, the new composite pharmacy adherence measure is a major step forward in our work to develop standard pharmacy performance measures focused on improving patient care.

Addressing Pharmacy and Stakeholder Interests

This measure addresses 3 key interests expressed by pharmacy stakeholders, including some communicated by the National Community Pharmacists Association and the National Association of Chain Drug Stores to the Centers for Medicare & Medicaid Services (CMS).³

First, it measures the performance of individual pharmacies and provides a basis for evaluating and rewarding pharmacies for the patients under their care.

Second, the measure’s composite approach is important when you’re evaluating pharmacies, many of which have small numbers of patients on certain medications (i.e., small denominators). As specified and endorsed, each pharmacy must have at least 30 eligible patients to be reliably evaluated by this measure. This minimum number for reliability is easier to reach with the composite measure.

Third, this measure is aligned with the PQA health plan adherence measures used in the Medicare Part D Star Ratings program. Therefore, it should be considered as a solution to align incentives between health plans and pharmacies who are working together to improve adherence.

Multiple pharmacy stakeholders have told PQA that the quality measures often used in their Part D agreements are health plan measures and do not accurately evaluate their contributions to adherence. This measure directly addresses that issue and provides an appropriate measure for individual pharmacy performance.

The PQA composite pharmacy performance measure was prioritized by our members and developed with input from a Technical Expert Panel that included 6 pharmacy and 6 health plan representatives. It was then successfully tested for pharmacy attribution for use in value-based plan-pharmacy agreements. Our collaborative, transparent and consensus-based process has consistently produced high-quality measures that balance the needs of relevant industry stakeholders.

Now Is the Time to Use Pharmacy Measures

Medication adherence continues to be an important part of evaluating and supporting high-value care. With the endorsement of this new pharmacy adherence measure, now is the time for pharmacies to advocate for its inclusion in agreements with health plans for 2023, which from an implementation standpoint is just around the corner.

PQA also endorsed in December a specialty pharmacy turnaround time measure that evaluates the average number of days between a specialty pharmacy receiving a new prescription for a specialty medication and the prescription being ready for pick-up or scheduled for delivery.

Work to Develop New Pharmacy Measures Continues

We are working now to develop and pilot pharmacy measure concepts for reporting, improvement and control of hemoglobin A1c and blood pressure.⁴ We also will begin work this year to develop a specialty pharmacy prescription abandonment rate measure.

Each of these pharmacy measures in development is aligned with pharmacy services that improve patient health outcomes. Collectively, they will form a set of standardized pharmacy performance measures that can be used across our care system.

Ultimately, the success of pharmacy measures depends on whether they are effectively used in the market. The composite adherence measure provides a tremendous and timely opportunity for pharmacies and health plans to pursue shared goals in value-based care, while laying the groundwork for the implementation of future outcomes-focused measures, which require time, relevant data sources and testing to develop.

From adherence to outcomes, PQA will continue to provide tools that evaluate care, help close gaps and improve patient health.

References

1. Pharmacy Quality Alliance. PQA Endorses Pharmacy Performance Measures for Medication Adherence and Specialty Turnaround Time. PQA website. pqaalliance.org/pqa-endorses-pharmacy-performance-measures-for-medication-adherence-and-specialty-turnaround-time. December 20, 2021. Accessed February 2, 2022.
2. Pharmacy Quality Alliance. PQA Measure Use in CMS’ Part D Quality Programs. PQA website. pqaalliance.org/medicare-part-d. Accessed February 2, 2022.
3. National Community Pharmacists Association and National Association of Chain Drug Stores.NCPA and NACDS Discuss Drug Pricing with HHS Officials. Indiana Pharmacists Association website. indianapharmacists.org/news/community-pharmacy-recommendations-for-measuring-quality-in-the-medicare-part-d-program/. August 3, 2018. Accessed February 2, 2022.
4. Pharmacy Quality Alliance. PQA Pharmacy Performance Measures in Development. PQA website. pqaalliance.org/pharmacy-measures. Accessed February 2, 2022.

About the Author

Micah Cost, PharmD, MS, is chief executive officer of the Pharmacy Quality Alliance, the national quality organization dedicated to improving medication safety, adherence and appropriate use. A non-profit, consensus-based organization, PQA has 250 diverse member organizations from across health care.