Quality Essentials Review: PQA Adherence Measures

The PQA Quality Essentials Webinar provides education on the fundamentals of quality measurement, which is important for effective measure implementation and performance, and information about where and how PQA quality measures are used.  

PQA’s March 24, 2022, Quality Essentials webinar welcomed Melissa Castora-Binkley, PhD, MA, PMP, Senior Director of Research at PQA and Ben Shirley, CPHQ, Director of Performance Measurement at PQA. Lisa Hines, PharmD, CPHQ, PQA's Chief Quality & Innovation Officer, served as moderator for the webinar.  

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Shirley opened the webinar by providing a brief overview of PQA's adherence measures, outlining the definition of adherence and describing the proportion of days covered (PDC) methodology. Shirley also discussed which PQA measures use PDC and which measures use other methodologies.  

Shirley detailed the Proportion of Days Covered: Renin Angiotensin System Antagonists (PDC-RASA) measure as an example of the architecture of a PDC measure. However, various PDC measures have differences in their specifications which are tailored to match the focus of each specific measure. 

Castora-Binkley provided insight into the implementation and impact of PQA adherence measures included in Part D Star Ratings, Quality Rating System, URAC and State Medicaid programs. She highlighted the 2021 National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Report, emphasizing that PQA's medication adherence measures accounted for approximately 90% of the total costs avoided. 

Shirley, Castora-Binkley and Hines clarified common misconceptions about PQA adherence measures which included:  

  • Because they do not directly assess medication taking, adherence measures are not valuable.
  • Adherence measures are topped out in the Part D Star Ratings. 
  • Adherence measures are gamed ​e.g., extended days’ supply, medication synchronization. 
  • Adherence measures should be replaced by​ clinical outcome measures. 
  • Adherence measures are pharmacy measures. 

Shirley discussed future directions for pharmacy measures, including the newlyPQA-endorsed pharmacy PDC composite measure and the technical expert panel (TEP) that PQA has convened to support the development of a health plan PDC composite measure.  

Castora-Binkley wrapped up this webinar by reaffirming PQA’s commitment to champion equity and address health disparities in medication use quality as described in PQA’s Blueprint 2025. In addition, she clarified stratification and risk adjustment in healthcare quality measurement.  

You can listen to the full recording of this Quality Forum Webinar, a one-hour presentation with audience Q&A, on PQA’s YouTube channel. PQA members can access the presentation slides in the Member Resources Library. 

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