PQA Hosts All Member Call to Discuss Strategic Plan Draft

As a broad-based, multi-stakeholder organization, PQA is seeking the input of its membership in finalizing its 3-year Strategic Plan. PQA is pleased to invite all members to a one-hour call to listen, learn and provide feedback to the recently retooled plan for PQA that has been developed by the PQA Board of Directors, leadership and staff.

PQA will hold this call on October 31st at 2 PM Eastern Time. During the call PQA leadership and staff will walk through the three strategic objectives delineated in this plan, along with the proposed new mission statement and other key elements of the plan.

PQA is now in its 6th year of operations and the new strategic plan will continue to drive the organization forward in pursuit of the core mission:

To improve the quality of medication use across health care settings through a collaborative process in which key stakeholders agree on a strategy for measuring and reporting performance information related to medications.

If you are unable to join on this call, PQA would still appreciate your input. Please send your questions or comments about the Strategic Plan to Laura Cranston at lcranston@PQAalliance.org or call PQA at 703-690-1987. You may use the link provided here to view the strategic plan draft. Your feedback would be appreciated before Friday, November 11th. Back to Top

A Beacon Communities Update: The PQA October Quality Forum Lecture Series

The Office of the National Coordinator allocated $265 Million over three years to 17 communities, including $15 million for technical assistance and evaluation to demonstrate the feasibility and the healthcare delivery benefits of widespread HIT adoption and exchange of health information.

As these 17 communities complete their first of three years of funding through the ONC, Beacon leaders established or strengthened governance mechanisms, formalized local project aims and related performance measures, and specified the interventions and technologies they'll use to achieve those aims. As they enter Year Two, Beacons are busily implementing technologies and interventions and collecting early data to inform further implementation. Mr. Brammer will review the successes and lessons learned to date in what is sure to be an engaging session.

The registration deadline for this one hour teleconference is October 11, 2011 at Noon EDT. REGISTER HERE
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Workgroups Make Progress towards Goals

The Adherence Workgroup, headed by Chris Dezii and Sharon Wang, reviewed the existing set of PQA adherence measures and provided guidance on the technical specifications.  Two subgroups have reviewed the literature and provided recommendation for determining adherence when patients use multiple medications in a therapeutic class and also when a patient switches from one medication to another in the same class.  This workgroup is considering additional therapeutic classes for adherence measures.  The Adherence workgroup is also represented on the Technical Expert Panel, which is developing a Primary Medication Non-adherence measure. The full workgroup will review and comment on this Panel's recommendation.

The Communications Workgroup, headed by Alicia DeStefano and Kelly Chillingworth, continues to help identify speakers and topics for the very successful monthly PQA Quality Forum Lecture Series. Currently topics and potential speakers have been identified through April of 2012. This workgroup is also looking for ways to reach a broader audience for the Quality Connection newsletter through social media and other creative methods. Members of the workgroup will also suggest articles for the newsletter that might appeal to a broader, less clinical audience.

Karen Farris and Terri Warholak lead the Education Workgroup.  This workgroup has framed a format for a series of high-level one-page articles about PQA and pharmacy quality.  Several PQA member organizations are interested in including these educational articles in their publications.  The workgroup has also brainstormed several approaches to increasing use of the EPIQ (Educating Pharmacy Students and Pharmacists to Improve Quality) curriculum.  Workgroup members attended the AACP meeting in July promoting EPIQ and providing CDs of the curriculum to those interested. The workgroup and PQA are considering a series of online webinars to engage and educate faculty about current quality initiatives and issues.

The MTM Workgroup chaired by Mary Ann Kliethermes discussed the standardized format for the CMR action plan and summary and the revised format.  The PQA used the MTM workgroup's comments to provide public comment to CMS.   The workgroup reviewed PQA's current MTM measures and measure concepts as well as a gap analysis between these measures and The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes. This workgroup brainstormed to create several measures related to medication management and is developing a measure concept to determine the impact comprehensive medication review and medication reconciliation have on readmission rates following a patient's discharge from the hospital.  The workgroup will also begin to develop an MTM outcomes measure concept (i.e., clinical indicators such as HbA1c, INR, lipids).

Donna West and Denise Kehoe lead the Overuse Workgroup.  Members of this workgroup have done a comprehensive literature search on several areas of medication overuse.  The workgroup has discussed proposed numerators and denominators for measures concepts including acetaminophen toxicity, upper respiratory infection, polypharmacy with oral antipsychotics and antidepressants, antipsychotic use in patients with dementia, chronic use of antibiotics in nursing home patients.

The Pain Management Workgroup, led by Todd Berner and Scott Strassels, has nearly completed developing technical specifications for one measure of pain management quality in palliative care patients, "Percentage of persons prescribed an opioid regimen with/without a bowel regimen."  The Workgroup is also discussing another measure concept related to the percentage of persons prescribed a long-acting, scheduled opioid with or without a short-acting/PRN opioid for breakthrough pain.

The Safe Dispensing Workgroup is co-chaired by Elliott Sogol and Dawn Blank.  This workgroup has also used subgroups to complete a literature review of nomenclature and definitions related to safe dispensing.  A subgroup developed a point-to-point dispensing chart that diagrams the dispensing process including key tasks in the (1) mechanical process/workflow and (2) cognitive tasks in the professional judgment and decisions made during intake, DUR and verification, and (3) communications with the patient at intake, at the point of sale, and possibly afterwards.  The full workgroup is nearing consensus on definitions for medication error, dispensing error and "near miss" as these relate to community pharmacy practice.

The State and Federal Workgroup chaired by Brendan Joyce will meet monthly in September, October and November. This workgroup has a different format than the other PQA workgroups.  During each call, two speakers provide information about medication measures used in public sector programs. Members of this workgroup are invited to listen, learn and discuss these programs as they relate to PQA activity or measures.  Back to Top

Hot Off the Press: Rapid Reviews of Key Quality Publications
by David Nau, PhD, RPh, CPHQ, Senior Director, Research & Performance Measurement, PQA

As the healthcare system searches for greater value, it is important that we understand the relationship between expenditures and quality to fully assess the efficiency and value of healthcare organizations.  NCQA has taken us one step closer to a better understanding of these relationships in a set of analyses published in the American Journal of Managed Care in August.

NCQA is well known for the measures of healthcare quality contained in their Healthcare Effectiveness Data Information Set (HEDIS); however, lesser known are the measures in HEDIS that pertain to efficiency or resource utilization.  These measures of relative resource utilization (RRU) are calculated for specific cohorts of patients (e.g., all persons with diabetes) by applying standardized prices to actual utilization for various subsets of healthcare services.  An RRU for medical care services can be created through aggregation of utilization data for inpatient facilities, procedures and surgeries (inpatient and outpatient), and evaluation and management services (inpatient and outpatient), and application of standard prices to each of these services.  An RRU for ambulatory pharmacy services is calculated by applying standard prices to the actual utilization of drugs for the target cohort of patients (thus it represents only drug utilization and not MTM services).   Based on data submitted by all health plans, NCQA calculates the expected RRU for the targeted disease states.  The expected RRU for medical care is essentially a severity-adjusted average across the plans.  A "RRU Index" can then be calculated for each health plan by dividing the plan's actual (i.e., observed) RRU by the expected RRU.   A RRU Index less than 1 indicates that the health plan incurs "lower than average" utilization of services for a specific cohort of patients.

The study by NCQA focused on quality and resource utilization for persons with diabetes or cardiovascular disease.  Composite quality scores for diabetes and for cardiovascular disease were converted to a quality index for each disease wherein an index less than 1 indicates that the plan has "lower than average" quality for the target disease.  For each health plan, the quality index and RRU index for each condition was used to categorize the health plan into one of four categories:  high quality/high utilization, high quality/low utilization, low quality/high utilization, low quality/low utilization.  This allows for a comparison of the relative value of each plan.  It also facilitated an examination of the relationship of quality with utilization for medical services and ambulatory pharmacy services.

Why This Study is Relevant
The methods described by NCQA provide a simple way of comparing the value of health plans.  By comparing both the relative quality and relative resource utilization, we get a more complete assessment of the plans.  The measurements of quality and utilization are not perfect (no claims-based measures ever are), but are a step in the right direction by providing practical tools for value assessment.

This study also reinforces the relationship of quality and utilization that has been found in studies of disease management or MTM services.  Higher medication utilization for diabetes goes hand-in-hand with higher quality.  Higher quality is also associated with lower medical utilization, especially inpatient services and procedures.   This study was not able to affirm the causal relationship of quality and costs, but other studies have shown that appropriate medication utilization for diabetes generally leads to better glycemic control and lower inpatient medical expenditures.

Highlighted Article:
Turbyville SE, Saunders SC, Tirodkar MA, Scholle SH, Pawlson LG. Classification of health plans based on relative resource use and quality of care.  Am J Manag Care 2011;17:e301-e309. Back to Top

Medicare Star Ratings to be released on October 12th

Each year, the Centers for Medicare & Medicaid Services (CMS) produce ratings of Medicare health/drug plans. The 2012 plan ratings will be released to the public on October 12th and will allow Medicare beneficiaries the opportunity to consider the quality of Medicare plans when enrolling for 2012. These plan ratings are also known as "star ratings" since each Medicare plan is rated on a scale of 1 to 5 stars. The ratings that are most relevant to prescription drug plans and pharmacies are the Medicare Part D star ratings. The Part D ratings are based on 17 measures of performance, including 5 measures from PQA.

Most of the Part D measures address operational and enrollment issues for the prescription drug plans including measures of telephone wait times, disenrollment rates and complaints. The five PQA measures focus on medication adherence or safety and are: (1) high-risk medications in the elderly; 2) use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEI/ARBs) in patients with diabetes; and measures of medication adherence for (3) oral diabetes medications, (4) ACEI/ARBs, and (5) cholesterol (statin) medications. Additionally, two other safety measures are used in the Display Measures that are used to provide feedback to prescription drug plans.  These include rates for drug-drug interactions and excessive doses of oral diabetes medications.

What's New for 2012?
There are several changes in the Medicare star ratings for 2012 including the addition of medication adherence measures to the Part D ratings, the implementation of a weighting scheme for the measures in the star ratings, and a Quality-Based Payment system for Medicare Advantage plans.  Three PQA measures of medication adherence (known as the Proportion of Days Covered, or PDC) join the 2 medication safety measures from PQA to yield a complement of 5 PQA measures within the Part D star ratings. The PQA measures are more heavily weighted than the other measures in the Part D ratings and thus account for nearly half of the plan's overall stars. More details are available from CMS at Prescription Drug Coverage Performance Data.

A very noticeable change to Medicare policy for 2012 is the implementation of Quality-Based Payments (QBPs) for the Medicare Advantage plans.  The QBPs were created in the Affordable Care Act but will be implemented in a modified form through a 3-year demonstration project.  In the demonstration, Medicare Advantage plans that achieve at least 3 stars will be able to participate in the QBP program.  Each eligible plan will receive an increase in their payment rates based on the number of stars (i.e., 3-star plans receive 3%, 4-star plans receive 4%, and 5-star plans receive 5%).  Considering that the base payments for Medicare Advantage plans are not expected to increase in the future, the QBPs represent their primary opportunity to keep pace with inflation and maintain profitability.  The average difference in payment for a 3-star plan versus a 5-star plan is approximately $16 per member per month.  For a Medicare Advantage plan with 1 million lives, moving from 3 stars to 5 stars would equate to nearly $200 million per year in additional revenue.

PQA applauds the efforts of CMS to bring greater attention to the quality of prescription drug benefits and to the role of medications in a high-value Medicare program. PQA encourages all members to become familiar with the Medicare Part D star ratings and to inform beneficiaries of the importance of considering the quality ratings when choosing a Medicare plan. Back to Top

Medicare Plan Finder to include MTM Program Information

This fall, the Centers for Medicare & Medicaid Services will include information about Medication Therapy Management programs in the Medicare Plan Finder. The Plan Finder has always included information about Part D programs to guide beneficiaries during open enrollment, which provides Medicare beneficiaries who are looking for a prescription drug plan a comparison of the available plans, formulary coverage, monthly premiums and a plan rating. New this fall, the Medicare Plan finder will also include information on MTM program eligibility.

The MTM information will be located on the "Your Plan Results" page through a link labeled View Plan Medication Therapy Management (MTM) Program Eligibility Information.   This link explains more about MTM eligibility and how the beneficiary may quality for the MTM program.  Beneficiaries will be able to view MTM program eligibility requirements two ways.  They can enter a Prescription Drug Plan and view the requirements or they are able to list their personal health conditions, medications and drug spending to match their condition to a MTM program.  This information will be provided for both the MA Prescription Drug Plans and the stand-alone Prescription Drug Plans.   Back to Top

Save the Date for the PQA 7th Annual Meeting!
June 13-15, 2012 in Washington, DC

Don't miss this meeting! Thought leaders, policy experts, government insiders, innovators and researchers within healthcare, will come together to share insights and ideas on medication use as it relates to quality performance, measurement and innovation in improving healthcare delivery and patient outcomes.

New this year, the meeting will kick off on Wednesday with the Keynote Address at 5PM, followed by a welcoming reception. Core meeting content will continue the next day  with healthcare leaders presenting the state of the industry from a variety of perspectives along with a closer look at the implications of the new Quality Based Payments tied to the Medicare Part D's Star Ratings. There will be interactive panel discussions, information on the Phase II Demonstration Projects and early reports on E-QuIPP (Electronic Quality Improvement Platform for Plans & Pharmacies). On Thursday, PQA will host the Quality Awards Program and will recognize health plans that have achieved excellence in medication quality and overall excellence in healthcare delivery to their patients based on the Star Ratings. Friday will feature Best Practices and Lessons Learned sessions. Throughout the Annual Meeting, ample time will be provided for networking and for renewing or building relationships with the diverse group of professionals and healthcare stakeholders in attendance.

There is no charge to attend the PQA Annual Meeting for PQA members. For non-members there is a $395 registration fee. The PQA Annual Meeting brochure and registration materials will soon be available.  The meeting is taking place at the Omni Shoreham in Washington, DC.

Back by Popular Demand! The Exhibit Area. Last year our exhibitor partners shared cutting edge technologies, both high tech and high touch, and demonstrated some of the latest advances in improving medication adherence and safety.  The exhibit program is designed to give each exhibitor maximum visibility and will be expanded to include 15 companies.  For more information contact Jackie Green at 703-927-1599 or jgreen@pqaalliance.org.

MARK YOUR CALENDAR so you don't miss this important event.  Back to Top

PQA Participates in the Accountable Care Advanced Measures: Applies Accelerated Solutions Design

PQA was pleased to be invited to participate in an ACO Advanced Measures Design Session, hosted in late September by Premier Healthcare Alliance, The Dartmouth Institute, the National Quality Forum, AAFP and the National Partnership for Women and Families. The Accelerated Solutions Design (ASD) is a unique and innovative methodology designed to spark creative solutions to critical issues that confront the healthcare industry and establish a clear commitment and plan for action. The ASD session was part of an initiative aimed at accelerating efforts to identify a measure set that can be used to assess the value of care provided by integrated delivery systems, such as ACOs.

The meeting objectives included reaching agreement on the domains of value that must be measured to meet the nation's expectations for ACOs to deliver value and identifying the capabilities and infrastructure (data platforms, data trusts and the use of measurement tools) that may be required to support value measurement in ACOs. The session provided a key initial step that will lead to the development of a specific action plan to measure value in ACOs through pilot testing and further development. A key goal is to secure a measurement approach for national deployment by January 2015, including the criteria to be used to select provider organizations to participate in the pilots. At press time, the complete conference findings were not yet reported. Stay tuned for more details in the next issue of the PQA Quality Connection. Back to Top

New National Priorities Partnership Report: A Review of the September Quality Forum Lecture

PQA is pleased to be a part of the National Priorities Partnership (NPP) and were especially grateful to have the National Quality Forum's Senior Vice President, Dr. Karen Adams, present to members in a recent Quality Lecture Forum.  Dr. Adams focused on the recent NPP report submitted to Secretary Kathleen Sebelius of the Department of Health and Human Services (HHS) in response to HHS's request for input on specific goals and measures for each of the six National Quality Strategy (NQS) priorities. The PQA worked directly with NPP to complete this report.

The HHS Secretary released the National Quality Strategy in March 2011, with the strong input of the National Priorities Partnership. Upon its release, NQS authors noted the need for further refinement, specifically around goals, measures, and public- and private-sector paths to implementation and improvement; subsequently, HHS again requested input from NPP to help make the NQS more actionable and measurable.

The NPP report is a public-private collaboration that highlights the opportunities we have now to align our focus and resources toward shared goals. NPP defined three categories of strategic opportunities that are critical for making progress:

• A national strategy for data collection, measurement and reporting that supports measurement-based improvement so we know "how we are doing" against the NQS;
• Community infrastructure (public-private) responsible for improvement efforts, resources for benchmarking and comparing performance and mechanisms to identify, share and evaluate progress; and
• Payment and delivery system report, emphasizing primary care that rewards value over volume and promotes patient-centered outcomes, efficiency and appropriate care while reducing waste.

Of particular relevance to the PQA, is the need outlined in the report to develop measure concepts for inappropriate medication use and polypharmacy for use at the national, community and system level to track inappropriate use of a set of medications for which evidence of harm or overuse is particularly problematic. Another area of interest to PQA is improving the quality of care transitions and communications across settings. PQA is aware of the vital role pharmacists can play in care coordination, and medication reconciliation, and is prepared to take a leadership role in addressing these areas.

There is a clear role for everyone in the healthcare system to take this plan from concept to clear results that can and will improve health and control costs by reducing duplicative and unnecessary services. To view a full table of the proposed measures and goals, please click the provided link: NPP_Report_2012_-_Proposed_Goals_and_Measures.

Convened by the National Quality Forum (NQF), NPP is a group of 48 organizations.  It provides guidance on building consensus on national priorities and goals for performance improvement and works in partnership to achieve those priorities and goals. NPP represents the full range of public- and private-sector stakeholder groups, including consumers, purchasers, health plans, clinicians, providers, communities, states, and suppliers. The primary goals of the NPP are to:

• improve the quality of American Healthcare by building consensus on national priorities and goals for performance improvement and working in partnership to achieve them;
• endorse national consensus standards for measuring and publicly reporting on performance; and
• promote the attainment of national goals through education and outreach programs

NPP Co-Chairs Dr. Bernie Rosof and Helen Darling have referred to NPP as the catalyst for change with public and private sector alignments.

For more information on the NPP or the Partnership for Patients, visit their respective websites at http://www.qualityforum.org/Setting_Priorities/NPP/National_Priorities_Partnership.aspx and http://www.healthcare.gov/news/factsheets/partnership04122011a.html
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Farris Selected to Serve on Key NQF Care Coordination Steering Committee

PQA is pleased to announce that Dr. Karen Farris has been appointed to the National Quality Forum's Care Coordination Endorsement Maintenance Steering Committee. This group will work on a two-phase project that will provide guidance and measurement around this important healthcare issue. Dr. Farris serves as Co-Chair of the PQA Education Committee. PQA nominated Dr. Farris for this NQF Committee based on her extensive research and expertise in this area.

In the first phase, the Steering Committee will address the implementation and methodological issues in data collection and data sharing required by effective care coordination. These issues include interoperability concerns, applicable data sources, patient self-report on coordination and attribution to multiple providers. The second phase of the project will seek to endorse performance measures for care coordination, with particular focus on the three prioritized gap areas: transitions across settings and providers; effective care planning to facilitate care; and appropriate and timely follow-up.

Care coordination is important in managing chronic conditions for which patients often receive care in multiple settings. According to data published in 2000, Medicare beneficiaries were treated by a median of two primary care physicians and five specialists and those with chronic conditions were treated by as many as 16 different physicians in a year. In addition, the population living with chronic conditions is steadily increasing. In 2000, 125 million people were living with at least one chronic illness; this number is expected to grow to 157 million by 2020. Back to Top

PQA Hosts Second Annual Leadership Summit

On Thursday, November 17th, PQA will host the 2nd Annual Leadership Summit to begin laying out plans for 2012. The Summit provides a critical opportunity for the PQA workgroup leadership to engage with the Board of Directors and senior staff to discuss their work from 2011. The discussions will include a thorough review of the proposed measure concepts developed by the respective workgroups, and the framework and guidelines developed by some groups.  The attendees will also explore what workgroups are needed in 2012 that will facilitate adoption and implementation of the PQA measures.

At this year's summit, PQA will have several speakers and presenters that are working on the nation's healthcare quality strategy. PQA aligns its work closely with the priorities and goals established by the National Priorities Partnership, which feeds into the National Quality Strategy Plan.  Attendees will also review PQA's proposed 3-year Strategic Plan, its three critical issues and share ideas on achieving the strategic objectives.

PQA would like to thank Merck for its generous support of this 2nd Annual Leadership Summit, which allows us to recognize and showcase the 2011 successes and accomplishments and strategically plan for a productive 2012. Back to Top

PQA Welcomes New Members: Community Pharmacy Foundation, Rite Aid Corporation, SXC Health Solutions and University of Florida College of Pharmacy

Community Pharmacy Foundation...
The Community Pharmacy Foundation is an organization whose primary purpose is to assist community pharmacy practitioners by providing resources for research and development to encourage new capabilities and continuous improvements in the delivery of patient care.

To that end, the Community Pharmacy Foundation awards grants in a variety of areas including disease state management, MTM, and patient safety.  PQA received an award from CPF in support of the Phase II Demonstration Projects.  In addition to financial support, CPF also provides a variety of resources on its website including a Pharmacy Resource Library, CPF Residency Support Section and a Best Practices section.  Go to www.communitypharmacyfoundation.org  for more information.

Rite Aid Corporation...
Rite Aid Corporation is one of the nation's leading drugstore chains with approximately 4,700 stores in 31 states and the District of Columbia, with a strong presence on both the East and West coasts, and 91,000 associates. Rite Aid is the largest drugstore chain on the East Coast and the third largest drugstore chain in the US and its mission is to be a successful chain of friendly, neighborhood drugstores. Their knowledgeable, caring associates work together to provide a superior pharmacy experience, and offer everyday products and services that help their valued customers lead healthier, happier lives.  For more information go to www.riteaid.com.

SXC Health Solutions....
SXC Health Solutions Corp. is a leading provider of pharmacy benefits management (PBM) services and Health Care Information Technology (HCIT) solutions to the healthcare benefits management industry. The Company's product offerings and solutions combine a wide range of PBM services and software applications, application service provider (ASP) processing services and professional services, designed for many of the largest organizations in the pharmaceutical supply chain, such as health plans, employers, federal, provincial, and state and local governments, pharmacy benefit managers, retail pharmacy chains and other healthcare intermediaries. SXC is headquartered in Lisle, Illinois with multiple locations in the US and Canada.  For more information please visit sxc.com.

University of Florida College of Pharmacy...
The University of Florida College of Pharmacy promotes the health and welfare of the citizens of Florida and the Nation by preparing graduates in Pharmacy to take independent professional responsibility for the outcomes of drug therapy in patients. Graduates have the scientific and cultural background necessary to assume leadership roles in the profession and the community.  For more information go to http://www.cop.ufl.edu. Back to Top