Happy Holidays from PQA

Volume 3, November/December 2009

Issue Contents

PQA Annual Meeting Summary: Successes to Date and Future Plans Click here for more information

Adams Shares Vision for the National Priorities Partnership with PQA Members Click here for more information

Moving the Measures: The Role of the Quality Measure Expert Panel Click here for more information

Phase I Demonstration Projects Share Lessons Learned as Groundwork for Phase II is Laid For more information click here

PQA Member Selected to NQF Measure Prioritization Committee Click here for more information

The Inside Scoop: Activity Reports from PQA Workgroups, Councils and Committees Click here for more information

AHRQ Announces Grants Supporting Comparative Effectiveness Research Click here for more information

PQA Annual Meeting Summary: Successes to Date and Future Plans

The 3rd PQA Annual Meeting took place on November 10th, 2009 in Arlington, VA when over 100 individuals actively participated in an action-packed agenda. The meeting serves as a critical event for evaluating progress on primary goals, establishing new directions and targets and allowing for face-to-face interaction of members.

Laura Cranston, PQA Executive Director, kicked off the meeting with a warm welcome and “thanks” to all those that have contributed to PQA success to date. Judith Cahill, PQA Vice Chair and Executive Director of the Academy of Managed Care Pharmacy also provided insights into the goals and progress of PQA, noting the achievements of the primarily volunteer-driven organization in just four short years.

The heart of the ambitious agenda included a review of the PQA Phase I demonstration projects and announcement of Phase II project selections by newly named Co-Chair of the Research Coordinating Council, Dr. Kristina Yu-Isenberg. (See article in this issue for more information.)

A highlight of the meeting was a presentation by Mark McClellan, MD, entitled “Health Reform: Linking Incentives to Drive Accountability and Value”. Dr. McClellan currently serves as the Director for the Engelberg Center for Health Care Reform at the Brookings Institution. In his former position as Administrator of the Center for Medicare and Medicare services, Dr. McClellan played a key role in the conceptualization and creation of the PQA. He congratulated the PQA on its tremendous accomplishments to date and commented on the optimal alignment of the organization’s goals with current health care reform activities.

Quality Measure Expert Panel Co-Chairs, Julie Kuehle and Kent Summers, shared their group’s work to date and mapped out the role of the QEMP in driving PQA-approved measures forward for NCQA validation. Lawrence “LB” Brown and Brad Tice, Co-Chairs for the Quality Metrics Workgroup, then facilitated presentations by the Co-Chairs of the 6 current cluster groups, each of whom shared their groups efforts. Three of the cluster groups offered up new measure submissions, which were well received by the attendees. Brief descriptions of the newly submitted measures, which will now be critically evaluated by the PQA Board of Directors and the QEMP in early 2010, are listed below. Detailed information can be found at the PQA website (http://www.pqaalliance.org/Nov102009Meeting.htm)

• Medication reconciliation in high-risk patients
• Identifying and improving potential medication adherence problems through MTM Service
• Resolving medication related problems through MTM services
• High-Risk medications in the elderly
• Diabetes suboptimal treatment
• Absence of a controller medication for asthma
• Diabetic patients with A1c< 9%
• Blood Pressure Screening: Percentage of patients > 18 years with documented blood pressure screening
• Preventive measure - Zoster immunization: Percentage of patients 60 years of age and older who have received a zoster vaccine directly from the pharmacy.

The Communications and Education Workgroup Co-Chairs, Kathleen Shoemaker and Steve Riddle, presented the accomplishments of their group. Notable were the creation of the new PQA Quality Connection newsletter and the PQA Quality Forum Lecture Series. A C&E subcommittee is also working on coordination joint publication of key findings from the PQA Phase I demonstration projects. Workgroup member and Assistant Professor at the University of Arizona, Terri Warholak, joined the Co-Chairs and shared with attendees details on the EPIC project, which seeks to improve knowledge of quality improvement and performance measurement for both practicing pharmacists and pharmacy students.

The meeting’s final presentation came from PQA member, Michelle Ketcham, PharmD, MBA, Director of Clinical and Operational Performance for the Medicare Drug Benefit for CMS. The presentation was entitled “A Perspective from CMS: The Role of Quality Initiatives and Performance Measurement within Medicare”. (See this issue for more information and a reprise of this presentation on the PQA Quality Forum Lecture Series.)

More detailed information on the PQA Annual Meeting discussions and outcomes will be included in the January/February 2010 issue of the PQA Quality Connection.

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Adams Shares Vision for the National Priorities Partnership with PQA Members

At the recent PQA Annual Meeting, attendees were fortunate to have Dr. Karen Adams serve as the keynote presenter. Dr. Adams presentation entitled, Transforming Healthcare from the Inside Out: The Role and Function of the National Priorities Partnership provided an engaging and informative overview of the partnership and the national priorities.

Dr. Adams leads the effort of The National Priorities Partnership (NPP), which was convened by the National Quality Forum. The mission of the NPP is to improve the quality of healthcare by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs.

Dr. Adams explained that the Priorities Partnership is comprised of 32 multi-stakeholder organizations that are committed to health care quality improvement through performance measurement and public reporting; are willing to work collaboratively; are prepared to advocate for the priorities, and are ready and committed to take action within their organizations to implement strategies for effecting necessary changes. Dr. Adams warmly welcomed PQA, one of the newest members, to the Priority Partnership and emphasized the critical role that pharmacists will play in NPP goal attainment for higher quality care.

According to Dr. Adams, setting the priorities involved evaluating the high impact areas of focus that leverage improvement in health care.  The priority areas identified and endorsed are:

• Patient and family engagement: include patient experience of care by widespread adoption of ambulatory CAHPS and patient self management.
• Population health: involves establishing guiding principles for endorsement of preventative services and health lifestyle including measures
• Safety: includes focus on healthcare-associated infections and serious adverse events
• Care coordination: includes preventable hospital readmissions and also medication reconciliation
• Palliative and end-of-life care: targets convening stakeholder groups and effective communication about treatment options
• Overuse: includes collaboration with IHI to promote appropriate use of medical and diagnostic procedures and also targets inappropriate medication use

There has been an overwhelming interest and response to participating on the priority working groups. The organizational goals and structure of PQA, particularly the efforts of the PQA work and cluster groups, are well aligned with these NPP focus areas. In fact, several PQA members have been selected to serve on the NPP work groups.  Dr. Adams concluded that there will be continued opportunity to align efforts around priorities and reach out to other stakeholder groups. For more information on NPP go to www.nationalprioritiespartnership.org.

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Moving the Measures: The Role of the Quality Measure Expert Panel

The Quality Measure Expert Panel (QMEP) was created to prioritize the measure concepts approved by the general membership. The PQA relies on the expertise of its various Committees and Cluster Groups to generate quality measure concepts. Significant resources are expended in the continued development, testing, and validation of these concepts to ensure they meet the criteria for being sound, evidence-based quality performance measures, and the QMEP prioritizes which measures should move to the critical next step.

The Quality Measure Expert Panel (QMEP) was initially charged with the prioritization of the 28 measure concepts approved by the general membership at the PQA annual meeting in November 2008. Eleven PQA members served on the QMEP, Co-Chaired by Kent Summers and Julie Kuhle. The QMEP conducted its work via teleconferences, during which the group reviewed each of the measure concepts and developed recommendations regarding which measure concepts should progress for further development, application and, possibly, submission for NQF endorsement. The Panel recommended that seven measure concepts move forward to be tested and validated by a measure developer. These seven measure concepts are addressing the following areas:

• Cardiovascular:  Rate of use of drugs for dyslipidemia in CAD
• Comprehensive Medication Review (CMR) 
• Medication Adherence: Proportion of Days Covered: HIV/AIDS Medications
• Medication Adherence: Proportion of Days Covered: Anticonvulsant Medications
• Patient Safety: High-alert Drug Review, Indicator 1 and Indicator 2
• Respiratory Disorders:  Asthma therapy with LABAs and Suboptimal asthma control

A final report of the QMEP will be submitted to the PQA Board of Directors for their review in the first quarter of 2010. The QMEP will also be looking to integrate into their recommendations the new measure concepts recently approved at the PQA Annual Meeting.

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Phase I Demonstration Projects Share Lessons Learned as Groundwork for Phase II is Laid

The five initial Phase I demonstration projects have completed or are nearing the finish line. These projects, critical to the PQA mission, have been testing the PQA measure “starter set” and the feasibility of creating pharmacy performance reports. Feedback was gathered from pharmacists on the performance reports to identify ways to further enhance the reporting systems.  Representatives from the 5 demonstration projects met in Washington DC on November 9th, just prior to the PQA Annual Meeting, to discuss lessons learned, key findings from the individual projects and issues related to publication and dissemination of the results to stakeholders engaged in the drive for higher quality healthcare. The 5 demonstration sites include (1) Highmark BCBS/CE City.com/RiteAid, (2) The Indiana Collaborative (Purdue University, Regenstrief/Indiana Health Information Exchange, CVS, Kroger, Wishard Health Services, Indiana Pharmacists Alliance), (3) Wisconsin Pharmacy Quality Collaborative (WPQC), an initiative established by the Pharmacy Society of Wisconsin and University of Wisconsin along with several payers in the state, (4) Outcomes-Kerr Drug Research Initiative (Outcomes Pharmaceutical Health Care, Kerr Drug) and (5) the University of Iowa Research Collaborative (including the Iowa Foundation of Medical Care, Iowa Medicaid Enterprise, and Wellmark). On November 10th, at the PQA Annual Meeting, each of the Phase I demonstration sites presented brief summaries of their experiences to attendees.

Current plans for publication of the findings include a qualitative review by the researchers summarizing results from all of the projects with health system policy implications, a descriptive review of the overall demonstration project published jointly by the primary investigators and a variety of reports submitted independently by the individual sites.

At the PQA Annual Meeting, Laura Cranston, PQA’s Executive Director, announced the collaborative teams that PQA will be working with in 2010 to develop Phase II projects.  PQA has begun work with Group 1 teams to seek external funds for the demonstration projects, and will next work with Group 2 teams.

Group 1

• Highmark BCBS/ Rite-Aid / CECity.com / University of Pittsburgh School of Pharmacy*
• Pharmacy Society of Wisconsin / University of Wisconsin*
• PharmMD Solutions / Healthspring / Emdeon
• University of Illinois-Chicago / Miami Humana HSRC / SUPERVALU

Group 2

• Purdue University / Regenstrief Institute / Wishard Health Services*
• University of Arizona / AZ Healthcare Cost Containment System
• Humana / University of Florida
• Outcomes Pharmaceutical / Kerr Drug/University of North Carolina-Chapel Hill*

The Phase II demonstration projects are expected to run from 18 months to as long as 5 years and will leverage the data, results and experiences from Phase I projects. While there will be variations in project design and specific outcomes between sites, examples of objectives include:

• Test and determine the effectiveness of one or more pharmacist-based interventions aimed at improving the quality of medication use
• Implement pharmacy performance report systems to track improvement in medication use quality
• Further evaluate the PQA starter set of measures while expanding the testing and validation of new measures
• Build the case with public and private payers for reimbursement of these quality improvement services. 

PQA is also encouraging Phase II collaborative teams to address one or more of the following additional objectives:

• Pay-for-Performance:  Test a pay-for-performance model or other financial incentive that reimburses the pharmacist’s time to provide the intervention(s), or develop the specifications for actuarial modeling of a pay-for-performance model.
• Causes of Low Performance Scores:  Determine the main underlying causes of low initial pharmacy provider level scores, e.g., why the patient skipped doses.
• Health Outcomes:  Further validate the measures by evaluating the impact of the interventions on established patient-health outcomes or medical measures (e.g., by linking to medical claims data).
• Negative Impacts:  To measure any negative effects of providing the intervention, such as impact on pharmacist workload or medication errors.

*Phase I Demo Sites

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PQA Member Selected to NQF Measure Prioritization Committee

In response to direction from the Department of Health and Human Services, the National Quality Forum (NQF) has undertaken work to lay out a strategy for identifying priorities for healthcare performance measurement. Carey.C.Cotterell, Pharmacy Quality and Patient Safety Leader with Kaiser Permanente, was selected to serve as a member of the new NQF Measure Prioritization Advisory Committee. The Advisory Committee members, representing a diverse set of stakeholders, will engage in a series of activities to identify gaps in endorsed measures, and will provide guidance on priorities for a measure development agenda.  The measure development agenda will be closely aligned with the ongoing efforts of measure developers and with the ongoing measure endorsement activities of NQF.

The Advisory Committee's work began in late October 2009 and is expected to be complete within 6-9 months. Specifically, this effort will involve; prioritizing the 20 conditions that account for over 95% of Medicare costs; identifying and prioritizing gaps in endorsed measures including those that map to the National Priority Partnership's crosscutting priority areas; finalizing gap-filling priorities, resulting in priorities for a measure development agenda; and providing guidance on a broader vetting process with measure developers and other key stakeholders.

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The Inside Scoop: Activity Reports from PQA Workgroups, Councils and Committees

PQA Introduces Five New Workgroups focused on Measure Uptake and Implementation Strategies: Laura Cranston, Executive Director of PQA, announced the creation of new workgroups for 2009/2010. These groups have been established to build awareness and promote adoption and uptake of the PQA measures to their targeted stakeholders.  The workgroups will begin meeting 4th quarter 2009.  Additional information will be forthcoming as these groups initiate their efforts.

The specific sectors that these five workgroups will be focusing on are included below, and the leaders that will be chairing the effort are also delineated:

• Commercial Insurer’s and Managed Care Plans - Chair: William Fleming (Humana)
• Pharmacy Benefit Managers (PBM) - Co-Chairs: Woody Eisenberg (Medco), Bimal Patel (MedImpact)
• Business Coalitions, Employers, & Benefit Consultants - Chair: Dennis White (National Business Coalition on Health)
• Public Payers (Federal Level) - Co-Chairs: Kim Caldwell (Humana), Vikki Oates (CMS)
• Public Payers (State Level, Medicaid) - Co-Chairs: Elgene Jacobs (OK State Univ.) Brendan Joyce (North Dakota Medicaid)

PQA is looking to add individuals with expertise in any of the above sectors to join this important effort to encourage meaningful uptake of the measures.

The Communications and Education Workgroup: This workgroup continues to operate via 4 subcommittees with distinct roles. One group has recently been refining the format and publication process for the PQA Quality Connection newsletter. Another group has coordinated two more offerings of the PQA Quality Lecture Forum series (see this issue for announcement details). One subcommittee member, Janet Hardy, attended the Nov 9th meeting of the demonstration project faculty to assist with planning for a joint publication of key information from the Phase I pilots. The EPIQ Project (Educating Pharmacy Students to Improve Quality), lead by subcommittee member Terri Warholak, has distributed the quality-focused curriculum to 36 schools of pharmacy of which 3 have already incorporated content. An outreach survey is being created to determine program uptake and outcomes.

Medication Reconciliation Cluster Group: On the recommendation from the PQA Quality Measurement Expert Panel, the “Med Rec” group has developed one additional measure for medication reconciliation for pharmacists practicing in the community setting. The new measure focuses on high-risk patients, identified in the community setting, who have experienced transitions of care (i.e. recent hospital or long-term care services). The group is also finalizing a concept paper for a demonstration project that will target the medication reconciliation process at the hospital to community transition in care. This concept paper for a collaborative demonstration project will utilize the medication reconciliation measures developed by the group. To date, the Med Rec group has created the initial infrastructure for the concept paper, including the goals and objectives, methods and design, data collection and analysis. Both the concept paper and the newly proposed measure were presented at the PQA annual meeting in November. The concept paper for a demonstration project will be finalized before the end of the year. To review the full measure concept, please click here.

MTM Cluster Group: The Medication Therapy Management cluster group has completed development of several quality measure concepts for MTM programs to be used at the pharmacy or health plan level. The NCQA/PQA measures recently endorsed by NQF served as the basis for these measure concepts, which start with identification of patients with medication-related problems or non-compliance, then measure the effects of an MTM intervention such as a comprehensive medication review or targeted intervention. To review the measure concepts that were approved by the PQA membership at their recent Annual Meeting, please click here.

The Prevention and Wellness Cluster Group: This group has formed three subcommittees and work has focused on development of four distinct measure concepts, including blood pressure screening, cholesterol screening, herpes zoster immunization and aspirin use in patients with cardiovascular disease. The blood pressure screening and herpes zoster measure concepts were presented at the PQA annual meeting for consideration of formal adoption by PQA. These measure concepts were approved by the PQA membership. They will move on to be reviewed by PQA’s Quality Measurement Expert Panel.

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AHRQ Announces Grants Supporting Comparative Effectiveness Research

The Agency for Healthcare Research and Quality (AHRQ) has opportunities under the American Recovery and Reinvestment Act of 2009 to provide patients, clinicians, and others evidence-based information to make informed decisions about health care. The Recovery Act contains $1.1 billion for comparative effectiveness research or CER. Of the total, $300 million is for AHRQ to build on its existing collaborative and transparent Effective Health Care program. This program allows for input from all perspectives into the development of the research and implementation of the findings. Of the remaining funds, $400 million each will go to the National Institutes of Health (NIH) and the Office of HHS Secretary. The legislation calls on the Institute of Medicine (IOM) to recommend research priorities for these funds and gather stakeholder input. In addition, the Federal Coordinating Council for Comparative Effectiveness Research was created to offer guidance and coordination on the use of these funds. For more info select this link CER at AHRQ.

AHRQ is gearing up to make the most of this additional funding by undertaking a process to determine what will be funded, as guided by the Federal Coordinating Council, the IOM and other external sources. AHRQ will be working closely with NIH and the Office of the Secretary to ensure that funds are used in the most effective manner and to coordinate plans to maximize effectiveness of this important investment.

The AHRQ Funding Opportunity Announcement invites Research Demonstration and Dissemination grant (R18) applications from organizations to extend the reach and impact of Comparative Effectiveness Research (CER) Reviews and associated products, particularly Comparative Effectiveness Research Summary Guides (CERSGs). Summary guides are intended to help bridge the gap between research and practice by translating and disseminating findings on the comparative effectiveness of clinical interventions for three broad audiences – patients/consumers, clinicians, and policymakers. For more information about CERSGs and CER Reviews respectively use these links:
http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=sg and http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=rr

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Patient-Centered Medical Home is Topic for PQA Quality Forum Lecture Series in December

C. Edwin Webb, PharmD, MPH, serves as the Associate Executive Director and Director of Government and Professional Affairs for the American College of Clinical Pharmacy. Dave Domann, MS, RPh is the Director of Future Market Strategies for Ortho-McNeil Janssen Pharmaceuticals. Ed Webb and Dave Domann serve as Co-Chairs for the PQA cluster group “The Pharmacist’s Role in the Patient-Centered Medical Home.”

Please join us in this very timely and informative discussion.

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CMS Quality Initiatives Focus of January PQA Lecture Series

On January 7th, 2010 the PQA Quality Forum Lecture Series will feature A Perspective from CMS: The Role of Quality Initiatives and Performance Measurement within Medicare presented by Michelle Ketcham, PharmD, MBA. The presentation will contain an introduction to Medicare’s new Part D plan rating program and new quality and safety measures for 2010, which include several PQA-constructed measures. This presentation was recently delivered at the PQA Annual Meeting on Nov. 10th, 2009 and is being offered a second time for those PQA members who were not able to attend the meeting.

Dr. Ketcham serves as the data analysis lead for CMS Division of Clinical and Operational Performance (DCOP) in the Medicare Drug Benefit and C&D Group within the Center for Drug and Health Plan Choice (CPC).

This one-hour lecture on January 7th at 1pm EST is offered via teleconference. Space is limited for this presentation, so please RSVP by Monday, January 4, 2010 to Karen Peterson, Administrator for PQA (kpeterson@PQAalliance.org) to reserve your place. Confirmation of participation and materials for the call will be provided on Tuesday, January 5th.

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