PRESS RELEASE

National Quality Forum Endorses PQA’s Risk Adjusted Adherence Measures

Alexandria, Va. (April 20, 2020) – The Pharmacy Quality Alliance (PQA) has developed a valid risk adjustment methodology for sociodemographic status (SDS) factors for three medication adherence measures used in the Centers for Medicare & Medicaid Services (CMS) Medicare Part D Star Ratings Program. The measures evaluate adherence, as determined by proportion of days covered (PDC), to medications for diabetes, hypertension and cholesterol. First endorsed by the National Quality Forum (NQF) in 2009, the endorsement was renewed in the 2019 Spring Cycle, which was finalized earlier this year.

“PQA has updated the methodology for our measures to make them more representative of our nation’s diverse populations,” Laura Cranston, RPh, PQA Chief Executive Officer, said. “Accounting for socioeconomic and demographic factors that may impact patient health outcomes is important for ensuring that quality measures are applied fairly. At a higher level, understanding patients’ risks can help us use our healthcare resources more efficiently and deliver high quality care.”

NQF recommends that performance-based measures be risk-adjusted for sociodemographic factors if there is scientific evidence that such factors affect the quality outcome measured. In response, PQA convened a Risk Adjustment Advisory Panel (RAAP) comprised of representatives from PQA’s multi-stakeholder membership with expertise in risk adjustment and statistical methods, health disparities research and medication adherence. The RAAP identified which PQA measures may be appropriate for SDS risk adjustment and the SDS characteristics to include in the risk adjustment methodology. 

Based on RAAP recommendations and subsequent testing results, PQA recommends that the three PDC measures be risk adjusted for Medicare Part D: 

• Diabetes All Class (PDC-DR) (NQF #0541)
• Renin Angiotensin System Antagonists (PDC-RASA) (NQF #0541)
• Statins (PDC-STA) (NQF #0541)

The SDS characteristics determined by the RAAP include age, gender, low income subsidy/dual eligibility status, and disability status. The PQA recommendations for risk adjustment were finalized upon completion of NQF endorsement maintenance of the measures. 

CMS will consider implementation of the PQA SDS risk adjustment recommendations for the three PDC Star Ratings measures in the future – for the 2022 measurement year or beyond. Substantive measure changes must be proposed and finalized through rulemaking.

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