The future of quality patient care relies on learning from the success stories and best practices of today in order to shape the healthcare system of tomorrow. Six Medicare plans were recently acknowledged by the Pharmacy Quality Alliance for excellence in medication safety, based on the Centers for Medicare & Medicaid Services’ Star Ratings.
The Chinese Community Health Plan of California, Humana’s Medicare plan in Illinois and four Kaiser Permanente regions (California, Colorado, Hawaii and the Mid-Atlantic region) were recognized for their achievement of a 5-star rating on the PQA measures of medication safety and appropriate use that are included in the CMS Star Rating Program for Medicare plans, as well as achievement of at least a 4.5-star summary plan rating.
The six award recipients spoke to the best practices that contribute to their outstanding medication management, and ultimately ensure optimal medication outcomes.
With the advent of new quality incentive structures put in place through federal government programs, health plans and PBMs are becoming increasingly focused on medication-use quality. Pharmacists can contribute meaningfully to the quality goals of these organizations as a member of a virtual integrated care team.
Of the 15 quality measures used by CMS to evaluate Medicare Part D plans in 2014, five relate to medication safety and adherence. These measures account for nearly 50 percent of a given Part D sponsor’s star rating, and represent a potential impact area for pharmacist intervention.
In fact, in a systematic review of interventions to improve adherence to medications for cardiovascular disease and diabetes, Cutrona et al. found that interventions in a pharmacy conducted by a pharmacist improved medication adherence more than any other professional in any other setting.
This represents a tremendous opportunity for pharmacies, but to take advantage of this opportunity, pharmacists must transition their approach from a mindset of quality measurement resistance, to quality measurement engagement. To facilitate this transition to becoming an engaged partner, many community pharmacies are using the Electronic Quality Improvement Platform for Plans & Pharmacies.
EQuIPP is a performance information management platform that provides unbiased, benchmarked data on the quality of medication use to both health plans and community pharmacies. It allows pharmacists at an individual store or corporate level, to see exactly how individual pharmacies are performing on the medication-use quality measures that matter to payors.
The unique position of pharmacists in the community setting grants enhanced patient access and excellent opportunities for medication management. Pharmacists are increasingly viewed as a key collaborative partner.
Managing the quality of medication use is now a recognized component of ensuring optimal care. Collaboration on shared quality targets and goals connects pharmacies to other partners along the care continuum.
Pharmacies are not exempt from quality measurement. Health plans and PBMs are already moving forward with incentive and penalty programs for pharmacies based on quality performance.
Pharmacists are an integral part of the solutions to meet payors’ quality needs. Being proactive in this new quality environment is a must.
Moving forward, pharmacists should look to initiate dialogue, establish and nurture relationships, and seek opportunities to deliver point-of-care interventions that drive quality.
Payors are not the only healthcare organizations with quality goals. Other healthcare organizations have performance measures that they are accountable for that can be directly influenced by pharmacists.
In addition to making contributions to health plan quality goals, pharmacists can reach out to local Accountable Care Organizations, and Patient Centered Medical Homes to look for collaboration points.
Examples of areas that pharmacists can impact include ACO measures of medication reconciliation and influenza immunization, or helping them reach quality measure goals related to cholesterol, A1Cs and blood pressure through appropriate medication management.
Of the 33 quality measures a federal Medicare Shared Savings Program ACO has to meet, at least 11 of them can be influenced by community pharmacists. Focus should be centralized on interventions that drive specific goals; communicating ways in which pharmacists influence the safe and effective use of medications and reach these goals will lay the foundation for the pharmacist’s role in integrated care teams.