PQA Appoints 17 Individuals to Serve on Health Plan PDC Composite Measure TEP

PQA has appointed 17 individuals from member organizations to serve on a technical expert panel (TEP) to review and provide input on draft specifications for a health plan measure concept: Proportion of Days Covered (PDC) Composite. 

The Health Plan PDC Composite TEP will provide expert input on the concept, which will be specified to provide one composite score reflecting health plan performance on multiple component adherence measures.  

The panelists were self-nominated and selected by PQA staff based on experience creating composite measures, expertise in statistical methodologies and administrative claims data and expertise on medication therapy to treat individuals with chronic conditions. The appointed panelists are: 

  • Monali Bhosle, CPESN USA 
  • Cassie Bobbitt, Arkansas Blue Cross and Blue Shield 
  • Linda Chung, Humana 
  • Richard Erickson, patient representative 
  • Lisa Erwin, Pharmaceutical Care Management Association 
  • Rita Hui, Kaiser Permanente 
  • Kyle Knudsen, Anthem 
  • Mary McLeod, Walgreens 
  • Christopher Powers, Cigna-Healthspring 
  • Theresa Prosser, University of Health Sciences and Pharmacy in St. Louis 
  • Russell Robbins, PurpleLab 
  • Mark Santilli, Magellan Rx Management 
  • Lindsey Shaffer, Aetna (CVS Health) 
  • Anita Sharma, Blue Cross and Blue Shield of Minnesota 
  • Will Stajnrajh, Highmark Wholecare 
  • Jennifer Van Meter, Novartis Pharmaceuticals Corporation 
  • Ann Wild, Tabula Rasa HealthCare 

The draft measure description and specifications will be informed and refined through TEP input. The TEP has three objectives: 

  • Address key questions identified during initial measure concept specification and initial feasibility assessments; 
  • Assist the PQA team in refining draft measure concept specifications; and  
  • Make recommendations on potential advancement of the measure concept for PQA Quality Metrics Expert Panel review prior to testing. 

PQA aims for this measure concept to advance through its consensus-based development process and to be put forward for public comment and endorsement consideration by the end of 2022. 

PQA Health Plan Adherence Measures and Support for a New Composite Measure 

PQA has developed and endorsed several PDC measures that assess adherence to medications used to treat chronic conditions. PDC measures are used in a variety of quality programs in the Medicare, Medicaid and commercial lines of business and have been associated with substantial cost savings 

For example, CMS found that estimated costs avoided between 2013 and 2018 due to improved adherence were $3.4-$7.2 billion for beneficiaries with diabetes, $18.2-$25.7 billion for beneficiaries prescribed RAS (renin-angiotensin system) antagonists for hypertension and $5.4-$13.7 billion for beneficiaries prescribed statins for cholesterol.  

A composite measure capturing adherence across multiple medication classes was identified as a measure concept of interest and prioritized for development by the 2021 Health Plan Measure Concept Advisory Group (MCAG). The Health Plan MCAG, a group of subject matter experts from PQA’s membership, provided guidance to prioritize areas of interest and refine a list of measure concepts, evaluating key criteria such as evidence supporting the rationale, opportunity for implementation, patient-centeredness, data source availability, resource-intensiveness of development and other important considerations.  

The MCAG recommendations were also subject to a public comment period, during which PQA received support for development of a health plan PDC composite measure. 

Visit our Measure Development page to learn more about PQA’s process for developing measures that matter. There are opportunities for all members to participate in the process, as well as nomination-based panels and groups like the Health Plan PDC Composite TEP. 

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