Issue #2, Sept/Oct 2009

PQA and NCQA Receive NQF Endorsement On Initial Set of Starter Measures
The National Quality Forum (NQF) concluded a year-long process of reviewing medication related measures with the endorsement on August 17, 2009 of 18 medication use measures. PQA and NCQA were pleased that of those 18 medication measures endorsed by the NQF, 5 measures arose from PQA efforts in working with NCQA as our measure developer.
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PQA is Inaugurated to the National Priorities Partnership Steering Committee

The Pharmacy Quality Alliance was officially granted a seat on the two-year old National Priorities Partnership Steering Committee, an initiative organized and staffed by the National Quality Forum (NQF). PQA had begun dialogue with NQF at the beginning of this year, seeking a position on the Steering Committee to assure appropriate representation for pharmacy and that appropriate medication use issues were fully integrated with this high-level, ambitious healthcare quality improvement body. On September 10, 2009, PQA participated in its introductory session with this august group
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A Roadmap for Quality Healthcare: Roski Lecture Lights the Way for PQA Members

On July 27^th, 2009 Dr. Joachim Roski kicked off the PQA Quality Forum Lecture Series with his presentation "Making Quality and Cost Measures Widely Available: a plan for making systematic progress over the next three years." Joachim Roski, PhD, MPH serves as the Managing Director for the High-Value Health Care Project at the Engelberg Center for Health Care Reform at The Brookings Institution and he is also directing and managing the efforts of the Quality Alliance Steering Committee (QASC) of which PQA is a member.

The lecture was "attended" by over 100 PQA members via a nationwide conference call. The intent of this lecture series is to engage leaders in the healthcare quality enterprise and to provide a venue for the exchange of information and ideas with PQA members; thereby bringing pharmacists deeper into the health care quality dialogue.
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Dr. Yu-Isenberg Appointed to Co-Chair of the PQA Research Coordinating Council
The PQA Board of Directors has announced the appointment of Dr. Kristina Yu-Isenberg, Director, Regional Outcomes Research, Southeast Operating Unit, Novartis Pharmaceuticals as the Co-Chair of the PQA Research Coordinating Council. Her efforts, together with Co-Chair Eleanor Perfetto, RPh, MS , PhD, will be much appreciated as they lead the effort within PQA to bring to a successful conclusion the five national Phase I demonstration projects this year. "Kristina's insights, strong leadership, and broad perspective will be most helpful in assessing and delineating lessons learned from Phase I demo projects as well as the identification of best practices also culled through this process" said Laura Cranston, RPh, Executive Director of PQA. PQA looks forward to Dr. Yu-Isenberg joining the leadership of this important council, and recognizes and extends its appreciation to Dr. Gene Reeder for his commitment to this group as Co-Chair for the past two years.
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PQA Congratulates Three PQA-Nominees on their Appointments to the National Priorities Partnership Workgroups
PQA participants Patrick Cory, RPh of Unity Health Insurance, Richard McLeod, PharmD, of Pfizer, Inc and Kathleen Shoemaker, PharmD, MBA of Eli Lilly and Company have all received appointments to three different workgroups formed as part of the National Priorities Partnership (NPP).
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Educating Pharmacy Students to Improve Quality (EPIQ): A complimentary, turn-key quality improvement program for pharmacy students
The EPIQ program was developed as a quality improvement educational resource to be used by pharmacy faculty and other healthcare educators to educate pharmacy students, pharmacists, and other healthcare providers about measuring, reporting, and improving quality healthcare. The program is comprised of 5 modules focusing on different aspects of quality and is designed for user-friendly implementation. If you would like to receive the EPIQ program materials - or know someone who might -contact Terri Warholak, PhD, RPh via e-mail:  warholak@pharmacy.arizona.edu or phone: 520.235.5529.
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Advancing Pharmacy Practice through Performance Measurement: Continuing Pharmacy Education Available 
An important goal for PQA is to increase awareness of pharmacists and other quality stakeholders regarding PQA initiatives and to educate practitioners, in general, about issues related to health care quality. To further this goal, PQA provided a grant to The Collaborative Education Institute (CEI) to disseminate continuing pharmacy education (CPE) to pharmacists and pharmacy technicians utilizing the content developed through the EPIQ program. The series of programs, entitled Advancing Pharmacy Practice Through Performance Measurement, is available on the CEI website at www.TheCEInstitute.org.
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The Inside Scoop: Activity reports from PQA Workgroups, Councils and Panels
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PQA and NCQA Receive NQF Endorsement On Initial Set of Starter Measures  

The National Quality Forum (NQF) concluded a year-long process of reviewing medication related measures with the endorsement on August 17, 2009 of 18 medication use measures. PQA and NCQA were pleased that of those 18 medication measures endorsed by the NQF, 5 measures arose from PQA efforts in working with NCQA as our measure developer.

The measures that were submitted to NQF were solicited in an open call for its Voluntary Consensus Standards for Medication Management project. This project sought to identify and endorse measures for public accountability and quality improvement related to medication management including key aspects of medication decision making, medication appropriateness and use, and monitoring.

The call for measures specifically cited that the measures should address the quality of medication management provided by Medicare Part D plans, health plans, clinicians, and pharmacists. Thirty-five measures were submitted by multiple measure developers during the open call for measures; 18 were approved for endorsement.

In response to the NQF open call, PQA submitted 14 of its starter set of 15 measures, through its measure developer, NCQA. One PQA-adopted measure was not submitted for endorsement within the Medication Management project because it was previously endorsed by NQF.  The 14 measures that were submitted for endorsement included:  

With an NQF-endorsed set of measures, PQA is well positioned to begin discussing these measures with a very broad-based group of stakeholders and to begin encouraging the appropriate use of these measures by health plans, PBMs, publicly funded programs, employers and business coalitions.

One of the first tasks for the new PQA Measure Uptake and Implementation Strategies Workgroups will be discussing how best to encourage appropriate uptake of these measures.

Click here for additional information about this NQF project and the endorsed measures. 

PQA is Inaugurated to the National Priorities Partnership Steering Committee 
The Pharmacy Quality Alliance was officially granted a seat on the two-year old National Priorities Partnership Steering Committee, an initiative organized and staffed by the National Quality Forum (NQF). PQA had begun dialogue with NQF at the beginning of this year, seeking a position on the Steering Committee to assure appropriate representation for pharmacy and that appropriate medication use issues were fully integrated with this high-level, ambitious healthcare quality improvement body. On September 10, 2009, PQA participated in its introductory session with this august group.

The National Priorities Partnership is committed to bringing together the leadership across healthcare settings and provider groups that have a commitment to real action that will transform the nation's healthcare system. The 32 partner organizations have significant influence over healthcare, uniquely positioning them to improve America's health and healthcare system. The Partnership has a vision for world class, affordable healthcare and is transforming healthcare from the inside out.

The September 10 meeting was used to chart the agenda for the Partnership for the upcoming year. Of particular importance for pharmacy are the initiatives focusing on continuity of care and reduction of overuse of medical services. Both priority areas offer genuine opportunity for pharmacy to have purposeful impact. Both initiatives are led by work groups which plan to convene venues for stakeholders in the arena to work collaboratively on what needs to be measured, how that will be accomplished, and what positive outcomes are anticipated. 

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A Road Map to Quality Healthcare: Roski Lecture Lights the Way for PQA Members

On July 27^th, 2009 Dr. Joachim Roski kicked off the PQA Quality Forum Lecture Series with his presentation "Making Quality and Cost Measures Widely Available: a plan for making systematic progress over the next three years." Joachim Roski, PhD, MPH serves as the Managing Director for the High-Value Health Care Project at the Engelberg Center for Health Care Reform at The Brookings Institution and he is also directing and managing the efforts of the Quality Alliance Steering Committee (QASC) of which PQA is a member.

The lecture was "attended" by over 100 PQA members via a nationwide conference call. The intent of this lecture series is to engage leaders in the healthcare quality enterprise and to provide a venue for the exchange of information and ideas with PQA members; thereby bringing pharmacists deeper into the health care quality dialogue.

Dr. Roski reviewed the proposed three-year plan or "road map" to significantly advance a nationwide data collection/reporting infrastructure and make performance measure results more widely available. The approach being taken is guided by public-private collaboration and builds on data sharing already in place to support care coordination and improvement. It does not create a separate data collection/reporting infrastructure.

Dr. Roski noted that there are many steps and stakeholder groups involved in the process of improving health care quality and value. He shared a wheel diagram that illustrated a 9-step cyclical process illustrating the discrete steps and the players involved in moving health care forward. "We must first set national priorities, develop evidence-based measures that identify what the components of 'quality' care might be, and endorse measures through a rigorous process involving diverse views" said Roski. He added that "strategies that will help us collect and analyze the right data are needed to produce meaningful performance information based on endorsed measures. For that, many organizations and entities must collaborate and work together to make that happen." Dr. Roski pointed out that a key role of the Quality Alliance Steering Committee (QASC) is to identify and promulgate best practices in data collection and aggregation to actually make performance information available. Dr. Roski specifically underscored the role that clinical registries could play in contributing to overall performance measurement with the primary goal being that the information is presented in a way that is useful for providers, patients, and those who pay for care. Dr. Roski concluded, "With this information, providers are in a position to improve care, consumers can use it to make good health care decisions, and payers can use it to reward high value care. The end result of all of this work is to achieve health care that is high-quality, equitable, cost-effective, and patient-centered."

For more information on the Quality Alliance Steering Committee go to www.healthqualityalliance.org

The PQA Quality Forum Lecture series will continue on a bi-monthly basis. Check this issue of the Quality Connection for information on the next lecture on Thursday, September 24^th at 1 PM EDT.
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Dr. Yu-Isenberg Appointed to Co-Chair of the PQA Research Coordinating Council
The PQA Board of Directors has announced the appointment of Dr. Kristina Yu-Isenberg, Director, Regional Outcomes Research, Southeast Operating Unit, Novartis Pharmaceuticals as the Co-Chair of the PQA Research Coordinating Council. Her efforts, together with Co-Chair Eleanor Perfetto, RPh, MS , PhD, will be much appreciated as they lead the effort within PQA to bring to a successful conclusion the five national Phase I demonstration projects this year. "Kristina's insights, strong leadership, and broad perspective will be most helpful in assessing and delineating lessons learned from Phase I demo projects as well as the identification of best practices also culled through this process" said Laura Cranston, RPh, Executive Director of PQA. PQA looks forward to Dr. Yu-Isenberg joining the leadership of this important council, and recognizes and extends its appreciation to Dr. Gene Reeder for his commitment to this group as Co-Chair for the past two years.

Dr. Yu-Isenberg is recognized as an expert in the area of health outcomes research, quality of care, value-based benefit design, and medication adherence.  She serves as a member of the National Quality Forum (NQF) Steering Committee for Ambulatory Care Measures and the Pharmacy Quality Alliance (PQA) Quality Measurement Expert Panel.  Dr. Yu-Isenberg received her PhD in health services research from the Johns Hopkins University School of Hygiene and Public Health; her MPH from the University of Massachusetts; and her BS in pharmacy from the University of North Carolina at Chapel Hill.  She is a licensed pharmacist in North Carolina and Virginia and a recipient of the National Research Service Award Training Grant with the National Institute of Mental Health.

PQA appreciates the efforts of all of our volunteer leaders and welcomes Kristina to this valued council.

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PQA Congratulates Three PQA-Nominees on their Appointments to the National Priorities Partnership Workgroups
PQA participants Patrick Cory, RPh of Unity Health Insurance, Richard McLeod, PharmD, of Pfizer, Inc and Kathleen Shoemaker, PharmD, MBA of Eli Lilly and Company have all received appointments to three different workgroups formed as part of the National Priorities Partnership (NPP).

Patrick Cory, RPh has been appointed to the Care Coordination Workgroup within the National Priorities Partnership. The goal of this workgroup is to ensure patients receive well-coordinated care within and across all healthcare organizations, settings and levels of care. Care Coordination has been identified as a national priority in recognition of the fact that patients with multiple chronic conditions often receive care form numerous healthcare organizations in multiple care settings and may see up to 16 physicians annually. As these patients attempt to navigate our complex healthcare system, and transition from one care setting to another, they are often unprepared or unable to manage their care.

Patrick is the Pharmacy Program Director at Unity Health Insurance in Wisconsin and Deputy Director of the Center for Drug Policy at University of Wisconsin Hospital & Clinics in Madison, WI. His involvement with PQA stems from his participation in the PQA-supported Phase I demonstration project being directed by the Pharmacy Society of Wisconsin.

Richard McLeod, PharmD has been appointed to the Patient and Family Engagement Workgroup within the National Priorities Partnership. The stated goal of this particular workgroup is to engage patients and their families in managing their health and making decisions about their care. The vision statement within the National Priorities Partnership for this workgroup is: We envision healthcare that honors each individual patient and family, offering voice, control, choice, skills in self-care, and total transparency, and that can and does adapt readily to individual and family circumstances, and to differing cultures, languages, and social backgrounds. 

Richard is a Medical Outcomes Specialist with Pfizer in their Global Medical division. He is a clinical pharmacist and holds faculty appointments at Oregon State University College of Pharmacy and Pacific University School of Pharmacy.

Kathleen Shoemaker, PharmD, MBA has been appointed to the Population Health Workgroup within the National Priorities Partnership.  As a National Priority, the implications for improved population health are profound. For the first time ever, the current generation of American children is not likely to live as long or be as healthy as their parents. A stronger, more productive population with a greater awareness of personal health and smarter lifestyle choices will drastically reduce chronic disease and allow for a more efficient and affordable healthcare system.

The Partners envision communities that foster health and wellness as well as national, state, and local systems of care fully invested in the prevention of disease, injury, and disability - reliable, effective, and proactive in helping all people reduce the risk and burden of disease.

Kathleen currently serves as a consultant in Federal and Quality Accounts for Lilly USA, LLC. She has an extensive pharmacy background that includes experience in both administrative and clinical pharmacy practice and issues. She works with national quality organizations and alliances on mutually beneficial projects. Her leadership roles with these organizations include Council Vice-Chair at NQF and Communication and Education Committee Co-Chair at PQA.  Kathleen convened the PQA/Indiana Pilot project with Purdue, IU Medical School, Regienstrief and Indiana Pharmacists Alliance.

All workgroups of the National Priorities Partnership will get underway this month. Patrick, Richard and Kathleen will provide a critical conduit to NPP allowing PQA to help advance these national priorities. Congratulations to all three on their placement!

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Educating Pharmacy Students to Improve Quality(EPIQ): A complimentary, turn-key quality improvement program for pharmacy students
The EPIQ program was developed as a quality improvement educational resource to be used by pharmacy faculty and other healthcare educators to educate pharmacy students, pharmacists, and other healthcare providers about measuring, reporting, and improving quality healthcare. The program is comprised of 5 modules focusing on different aspects of quality and is designed for user-friendly implementation. If you would like to receive the EPIQ program materials ? or know someone who might - contact Terri Warholak, PhD, RPh via e-mail:  warholak@pharmacy.arizona.edu or phone: 520.235.5529.

The American Association of Colleges of Pharmacy (AACP) and the Accreditation Council for Pharmacy Education (ACPE) have recognized the needs for future pharmacists to understand quality improvement. They have encouraged the addition of "quality improvement" (QI) to the curricula of Colleges of Pharmacy (ACPE 2007). The ACPE states in their accreditation standards effective July 1, 2007 (p14): "As recommended by the Institute of Medicine for all health care professionals, pharmacists must be educated to deliver patient-centered care as members of an interprofessional team, emphasizing evidence-based practice, quality improvement approaches, and informatics."

The Pharmacy Quality Alliance (PQA, Inc) is committed to improving medication use and has provided a grant to three pharmacist educators (Terri L. Warholak, PhD, RPh; Donna West, PhD, RPh; and David Holdford, RPh, MS, PhD) to create the EPIQ program.

The EPIQ program is available at no cost and is currently ready for distribution to schools/colleges of pharmacy for educational use. The program includes complete educational materials (slides, speaker notes, activities, readings, assessment questions, etc.) for the following topics: 
Module I:   Status of Quality Improvement (QI) and Reporting in US Health Care System
Module II:  Quality Improvement Concepts
Module III: Quality Measurement
Module IV: Quality-Based Interventions and Incentives
Module V:  Application of QI to the Pharmacy Practice Setting

To receive the complimentary EPIQ program materials or for more information contact Terri Warholak, PhD, RPh.

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Advancing Pharmacy Practice through Performance Measurement: Continuing Pharmacy Education Available

The first program in the CEI series discusses why quality improvement initiatives are the key to patient safety, the value pharmacists contribute to the health care system and how that value will likely be measured. This program is available as a webcast or a monograph at the CEI site. The second program focuses on performance report cards. Public reporting of performance data is now becoming common place in healthcare and can play a powerful role in driving quality. This program describes the role of public reporting and reporting to healthcare providers and provides examples of potential pharmacy report cards.  The program discusses what pharmacists can do to prepare for this new aspect of pharmacy practice. The final program in this series - a webinar that will be available in November - will discuss performance reports and pay-for-performance systems, as well as pharmacy measures that will enhance the quality of care provided by pharmacists.

In addition to these educational offerings on the website, CEI has partnered with Drug Store News to disseminate them through their live webinars and Pharmacy Practice publication. These materials are also available to state pharmacy associations across the entire country for live educational programs and via web-based activities. Over 1000 pharmacists have already participated in one or more of the educational sessions.  If you have questions about the educational offerings, please contact Jennifer Moulton, jmoulton@iarx.org.
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The Inside Scoop: Activity reports from PQA Workgroups, Councils and Panels
Communication and Education (C&E) Workgroup: This workgroup has four active subcommittees, each with a unique focus. A recent effort from one of these subcommittees includes the continued publication and refinement of the PQA Quality Connection newsletter which is now targeted for bi-monthly distribution.

A second subcommittee is advancing education on quality improvement and performance measures to pharmacists and pharmacy students via the EPIQ project (a full course curriculum on quality for schools of pharmacy) and with the help of the Collaborative Education Institute (CEI). The EPIQ project goals and curriculum were recently presented at the AACP conference, which featured a training session, and the NIQUE conference. It is reported that several schools of pharmacy are using the course material. This C&E subcommittee will undertake a project this fall to track who and how the course material is being used.  There is a need for students to participate in this as a student project.  Please contact PQA if you are interested in participating.    Also, CEI hosted a webinar on pharmacy-focused performance reports in August.  This is one of three CE modules for practicing pharmacists. NASPA has also partnered with CEI to support live CE modules at state pharmacists' association meetings for one of the modules.  Several PQA members have now presented the CE module at different state meetings and report it generally well received. The third module on pay-for-performance will be released in November.

The third subcommittee has been engaging the PQA investigators from the Phase I PQA demonstration projects to coordinate a communication strategy that includes live presentations at healthcare association meetings, joint publications in peer-reviewed publications as well as publications in appropriate trade press journals, magazines and the like. This effort is underway, with publications and presentations being targeted for the first and second quarters of 2010.

The fourth subcommittee is tasked with bringing national leaders from the "quality enterprise" to the PQA membership via the PQA Quality Forum Lecture Series. To date, Joachim Roski from the Brookings Institution and Karen Adams from the National Priority Partnership have been scheduled.  The subcommittee will meet to identify the winter engagement shortly.

Cost of Care Workgroup: This group nearing completion of a White Paper on the Cost of Medication Therapy Management (MTM). This White Paper, a compilation of the contributions of 7 members from the group, is based upon an extensive review of the published literature coupled with personal knowledge and group member experiences.

MTM Cluster Group: The group is continuing to refine new Medication Therapy Management (MTM) measures. These measures relate to the impact of comprehensive medication review (CMR) on adherence and the frequency of resolution of medication related problems. The group's current focus is on defining therapeutic classes for which medication adherence will be measured. Specifying medication related problems is also an area of emphasis. In addition, subgroups are being formed to finalize the proposed measures for presentation at the PQA Annual Meeting on November 10^th in Crystal City, Virginia.

Pharmacists' Role in the Patient Centered Medical Home Workgroup: The workgroup recently reviewed a document prepared for the Patient Centered Primary Care Collaborative (PCPCC) by Linda Strand, Terry McInnis and Ed Webb, titled, "Framework for a Patient-Centered Medical Home (PCMH) - Integrating Medication Management to Optimize Patient Care." This document lays out the medication management process in a patient centered medical home. The workgroup also reviewed best practices in medication management that was prepared by several group members. Additionally, an inventory of medication management measures was reviewed by the workgroup.

This PQA workgroup has established an objective to "define the quality measurement framework to support measurement and reporting of the services delivered in medication management as defined by the PCPCC." The workgroup activities are now dependent on completion of the PCPCC document referenced above, which is expected to be finalized soon. At that time they will complete a framework for measurement of medication management practices and define the types of quality measures to be included.

Prevention and Wellness Cluster Group: This group broke into 3 subcommittees during the summer months to draft measures in three different wellness and prevention areas. The three subcommittees are: 1. Immunizations, 2. Health Screenings and 3. Aspirin Therapy (for vascular event prophylaxis). These subcommittees were selected to align with the wellness and prevention initiatives of the National Priorities Partnership.

At the next cluster group meeting the subcommittee chairs will be presenting their final measures. The cluster group will vote to determine which measures will move forward for presentation at the PQA Annual Meeting on November 10^th in Crystal City, Virginia.

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PQA Announces Annual Meeting Date: Mark Your Calendars for November 10, 2009
The Pharmacy Quality Alliance will host its Annual Meeting on Tuesday, November 10^th, 2009 in Crystal City, Virginia (close proximity to Washington Reagan National Airport).

The action-packed agenda includes Dr. Mark McClellan, Director, Engelberg Center for Health Care Reform at the Brookings Institution who will discuss "Health Reform: Linking Incentives to Drive Accountability & Value" and Dr. Karen Adams, Vice President of National Priorities, National Quality Forum who will share her vision of "Transforming Healthcare from the Inside Out: The Role and Function of the National Priorities Partnership".

Additionally, we will be showcasing the best practices and lessons learned from the recently completed PQA Phase I demonstration projects.  PQA's Quality Metrics Workgroup leaders and PQA's Research Coordinating Council will highlight new measure concepts, recent NQF-endorsed measures, and most importantly, we will use this time to lay out the agenda for 2010 in terms of both measure implementation and new research initiatives.

The meeting will take place at the Marriott Crystal City at Reagan National Airport.  Don?t miss out on this exciting and informative PQA event! Registration is complimentary for members and a nominal registration fee is charged for non-member organizations. For information on registration and to view the agenda go to http://www.pqaalliance.org or click PQA Meeting Info.

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2009 PQA New Members

Avatar International, LLC is a partner in the measurement and continuous quality improvement space. Avatar works with healthcare systems, hospitals, physician groups, and other healthcare entities to implement HCAHPS, employee, patient, pharmacy and physician surveys. Avatar is a partner in a PQA-funded Phase I demonstration project.

CECity is a provider of online CME, quality improvement and outcomes platforms and services designed to support healthcare professionals. CECity develops technologies designed to support healthcare professionals in their pursuit of quality and outcomes. CECity is a partner in a PQA-funded Phase I demonstration project.

Gold Standard is a developer of drug information databases, software, and clinical information solutions. Gold Standard's mission is to improve the quality of patient care by providing to their clients a source for the highest caliber of drug information and solutions.

Merck & Co., Inc. is a global research-driven pharmaceutical company dedicated to the discovery, development, manufacturing and marketing of vaccines and medicines to address unmet medical needs. The Company focuses its efforts to increase access to medicines. Merck also publishes unbiased health information as a not-for-profit service.

The National Institute for Quality Improvement and Education (NIQIE) supports the integration of quality improvement and continuing education for health professionals with the goal of improving patient care. NIQIE focuses on closing the quality/education gap through education, research, translation and publication.

Prime Therapeutics is a privately held pharmacy benefit management company based in Minnesota that represents 11 Blue Cross and Blue Shield Plans, covers 14.7 million lives and had a managed drug spend of $8.6 billion in 2008.

Surescripts operates the largest electronic prescribing network and provides healthcare professionals secure, electronic access to prescription information. The Surescripts network connects prescribers to the nation's major chain pharmacies, payers, PBMs and over 10,000 independent pharmacies. Surescripts is the result of a 2008 merger between the country's two leading health information networks: RxHub and Surescripts.

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