The Pharmacist’s Role in Quality:A PQA Demonstration Project

Mark Conklin, PharmD, MS

September 16, 2009

The Pharmacy Quality Alliance Established in April 2006, as a public-private partnership.

Drs. Mark McClellan & Carolyn Clancy - Inaugural PQA Steering Committee members.

Consensus-based, membership alliance with over 50 members.

PQA is a nonprofit 501(c)(3) organization.

Mission: 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.

PQA Board of Directors•Steven Anderson, NACDS•Judy Cahill, AMCP•Laura Cranston, PQA, Inc.•Woody Eisenberg, Medco•John Feather, ASCP•William Fleming, Humana, Inc.•Karen Ignagni, AHIP•Jeffrey Kelman, CMS•David Marshall, Teva USA•Mark McClellan, Brookings•Thomas Menighan, APhA•Eleanor Perfetto, Pfizer•Bruce Roberts, NCPA•Lee Rucker, AARP•Bruce Sherman, Goodyear Tire Co.•Becky Snead, NASPA

Who’s at the PQA Table?

• Pharmacy Trade Groups• Managed Care Organizations• Health Plans• AARP• Consumer Advocacy Groups• Pharmacy Practitioner Groups• PBMs• Employer Coalitions• Pharm. Manufacturers• Health IT Vendors• MTM Vendors• Chain Drug Companies• Independent Pharm. Owners• Outcomes Researchers

PQA Organizational Workgroup Structure 2009

PQA Board of DirectorsPQA Board of Directors

Executive DirectorExecutive DirectorAdministratorAdministrator

DirectorResearch & Practice

Improvement

DirectorResearch & Practice

Improvement

DirectorGrants & Sponsored

Programs

DirectorGrants & Sponsored

Programs

DirectorMembership &

Outreach

DirectorMembership &

Outreach

Research Coordinating Council

Research Coordinating Council

Quality Metrics Workgroup

Quality Metrics Workgroup Measure Uptake and

Implementation Strategies

Group

Measure Uptake and Implementation

Strategies Group

Cluster Groups

Cluster Groups

Pharmacist RoleIn Medical Home

Pharmacist RoleIn Medical Home

MedicationReconciliation

MedicationReconciliation

MTM ServicesMTM Services

Prevention &Wellness

Prevention &Wellness

Cost of CareCost of Care

Patient SafetyPatient Safety

PBMPBM

BusinessCoalitions, Employers, Benefit Consultants

BusinessCoalitions, Employers, Benefit Consultants

Public PayersFederal Level

Public PayersFederal Level

Public PayersState Level(Medicaid)

Public PayersState Level(Medicaid)

CommercialInsurers & Managed

Care Plans

CommercialInsurers & Managed

Care PlansRFP DevelopmentRFP Development

Funding SourcesFunding Sources

Research PrioritiesResearch Priorities

Education &Communication

Workgroup

Education &Communication

Workgroup

Oversight of Demo Projects

Oversight of Demo Projects

Quality Measurement Expert Panel

Quality Measurement Expert Panel

Demonstration Project

Demonstration Project Objectives

Determine resources requirements for collecting/aggregating prescription claims data and calculating the 15 PQA quality measure scores

Collection of patient experiences with pharmacy services using the PQA-sponsored survey

Generate/test models of providing pharmacy

performance reports

Get feedback from pharmacists on the reports’ accuracy, user-friendliness and value in improving quality

PQA-Sponsored Demonstration ProjectsDemo Type

(Data Source)Project Leader Partners

Health Plan Highmark BCBS CECity.com, Inc. Rite Aid

Community Pharmacy Corporation

Outcomes Pharmaceutical Health Care

Kerr Drug

Coalition of Health Plans

Pharmacy Society of Wisconsin and Wisconsin Pharmacy Quality Collaborative

State of Wisconsin Dept of Health and Family Services

United Healthcare of Wisconsin Unity Health Insurance and Group Health Cooperative of South Central

Wisconsin

Coalition of Health Plans

Purdue University School of Pharmacy

Indiana Pharmacists Alliance Indiana Health Information Exchange Regenstrief Institute

Coalition of Health Plans

University of Iowa

Iowa Foundation for Medical Care, Wellmark Blue Cross and Blue Shield Iowa Medicaid Enterprise

Project Team & Roles

Highmark Blue Cross Blue Shield Data source, Project coordination & strategy

CECity (Annette Boyer) Technology vendor

Rite Aid (Rick Mohall) Pharmacy provider (n = 50)

Avatar International (David Medvedeff) Administrator, consumer experience survey

Pharmacist Training

2 hour live training sessions 90+ pharmacists Topics:

Introduction to performance measurement & reporting Specific education on the quality metrics to be used Reporting process Future & importance of focus on clinical activities and

quality improvement

Initial Pharmacist Perceptions

Excitement Means to expand the clinical role of the RPh Input into the performance measurement process Strong sense of self-efficacy to provide quality care

Concern What about claims not captured by the health plan? Will the time and resources be available to allow the

RPh to move the metrics in a positive manner? Physician acceptance of interventions Proper team approach to care of mutual patients

Demonstration Project Process Flow

Health Plan Data Warehouse

CECity’s Lifetime™ Platform

Rite Aid Pharmacists

Collaborative Feedback & Analysis

Quantitative & Qualitative Feedback

Rx Claims Data for the 15 PQA measures & survey

Performance Reports

Measures grouped by

category

Measures grouped by

category

• Arrow indicates direction of change from previous period.• Color indicates if the change occurred in the recommended direction.

• Arrow indicates direction of change from previous period.• Color indicates if the change occurred in the recommended direction.

Comparison against peersComparison

against peers

Measure value and number of patients

Measure value and number of patients

Image: PQA Demonstration Project

Additional information on

peers

Additional information on

peers

Detailed analysis over time

Detailed analysis over time

Measure DefinitionMeasure Definition

Image: PQA Demonstration Project

Pharmacist Feedback

Electronic feedback survey Completed after viewing each round of the

performance reports

Pharmacist focus group Conducted 1 week after the final round of reports was

closed

Pharmacist feedback – 1st round

Statement Positive Neutral Negative

Understanding 51 21 6

Helpfulness of educational information provided with the report

46 25 7

Accurate measures of quality performance?

28 33 17

Self-efficacy for ability to impact measures

35 27 3

5-point Likert-type scale (1 = Strongly agree to 5 = Strongly Disagree)

Pharmacist feedback – 2nd round

Statement Positive Negative

Understanding 35 9

Helpfulness of educational information provided with the report

31 12

Accurate measures of quality performance?

26 17

Self-efficacy for ability to impact measures

28 10

6-point Likert-type scale (1 = Strongly Agree to 6 = Strongly Disagree)

Pharmacist feedback – Barriers

Operational barriers (i.e. lack of time, resources) Health plan/insurance barriers Physician barriers Physician office staff barriers Organizational barriers (i.e. lack of corporate

support)

Best Practice Concepts Content

Use of nationally recognized, standardized performance metrics Interventions for improvement should be linked to practice needs

Process Multi-disciplinary stakeholders Integration into workflow Meaningful reporting that is actionable, scalable

Technology Secure, web-based platform that supports customizable

dashboards to present quality data/measures to the participating pharmacies

User friendly, easy to navigate platform Scalable with ability to coordinate data from multiple sources

Next steps: “Phase 2”

Can pharmacists/pharmacies engage in meaningful performance improvement strategies?

What data is necessary to inform a new model for pharmacy reimbursement? Sustainable business model for quality care?

What mechanism(s) can be employed to provide pharmacy quality information to consumers?

Targeted QI strategies

Consumer quality information

Next steps: Targeted QI Example

You are here – So do this

You are now here – So now do this

Questions and discussion