Adapting PQA’s Claims-Based Opioid Quality Measures to PDMP Data

Prescription opioid-related deaths are one of the leading preventable public health problems. High-risk prescribing practices have contributed to the opioid overdose epidemic. These include overlapping opioid and benzodiazepine prescriptions, prescribing high-dose opioids and using multiple prescribers or pharmacies for opioid prescriptions. 

The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) set aside special provisions to leverage Prescription Drug Monitoring Programs (PDMPs) to address opioid morbidity and mortality among Medicaid beneficiaries in the United States. PDMPs are electronic databases that collect information about controlled substance prescriptions dispensed across all payment methods at the state level. Therefore, one key strategy is to use PDMPs to address the opioid epidemic in the United States. 

The SUPPORT Act provides resources for developing PDMPs capable of reporting on four specific opioid quality measures. Recently, the Chesapeake Regional Information System for our Patients (CRISP), The Pharmacy Health IT Collaborative and the Pharmacy Quality Alliance (PQA) partnered to test and adapt the following claims-based opioid quality measures specified for health-plan performance to PDMP data for state-level performance: 

  1. Concurrent Use of Opioids and Benzodiazepines (COB) (NQF #3389) 
  2. Use of Opioids at High Dosage in Persons Without Cancer (OHD) (NQF #2940)  
  3. Use of Opioids from Multiple Providers in Persons Without Cancer (OMP) (NQF #2950)  
  4. Use of Opioids at High Dosage and from Multiple Providers in Persons Without Cancer (OHDMP) (NQF #2951). 

Various federal programs such as Medicare Part D Quality Programs and the Medicaid Adult Core Set use these measures. The adaptation of these quality measures was successful, and testing showed alignment with the measure as specified, allowing for the calculation and reporting of these measures to CMS. This is important because through the SUPPORT Act, CMS has encouraged states to report opioid quality measures to facilitate program evaluation, continuous improvement and transparency.  

In Maryland, the updated measures will be implemented within the CRISP MD data repository, linked with PDMP data, Medicaid and other datasets. This analytic infrastructure will allow for the regular reporting of the measures to the PDMP program, Medicaid program and CMS. 

CMS will require states to report behavioral health measures in the adult core set, beginning with reports for FY2024, specifically the Use of Opioids at High Dosage in Persons Without Cancer (NQF #2940) and Concurrent Use of Benzodiazepines (NQF #3389)Therefore, other states may leverage their PDMP data to calculate the performance measures. Nearly all states have statewide PDMP and Medicaid data. Therefore, this project may be replicated in other states, provided legal pathways exist to combine the disparate datasets. 

 Successful reporting using PDMP data in the future could provide high clinical value. Ultimately, quantifying outcomes related to these adapted measures will inform our learning health care system and help curb opioid drug misuse, opioid drug overdose and opioid drug-related fatalities. 

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