David Nau, PhD, RPh, FAPhA
President Pharmacy Quality Solutions, Inc
Did you know that an increasing number of Medicare prescription drug plans are tracking and evaluating patient outcomes data, and are using that data to determine which pharmacies can participate in their preferred networks? In true 'pay for quality' form, they're also creating financial incentives to reward pharmacies that deliver the best patient outcomes.
Community pharmacy has long been lauded as one of the most cost-efficient, convenient and accessible touchpoints for patient care. Every day, community pharmacists deliver preventive care and wellness services, medication therapy management, adherence and reconciliation programs. And we know that community pharmacists are often the health care provider patients see and interact with most.
But until now, community pharmacies have not had access to the kind of data that helps them empiracally demonstrate the impact their care has on patient outcomes. Community pharmacies have been 'flying blind,' without the ability to know what their own quality metrics are, or how they stack up to competition in their own communities or across the nation.
The good news is that now, for the first time, through a tool called EQuIPP (Electronic Quality Improvement Platform for Plans & Pharmacies), community pharmacies can access individual store data that tracks their performance on key quality indicators and compares it to state and national benchmarks. Armed with this information, pharmacists can better understand how they are being measured, where they are having the best impact on quality, and identify opportunities to improve the care they deliver. Read on to learn more about what quality of care measures are being tracked, and how community pharmacies can learn more about their scores.
For several years, The Centers for Medicare & Medicaid Services (CMS) has been evaluating all Part D prescription drug plans using a Star Rating system. Medicare prescription drug plans receive a summary "Star Rating" on quality, based on their performance across 15 individual measures. Five of those measures are specifically related to medication management and use. And, because CMS more heavily weights those 5 measures, they account for nearly half of the plan's Part D summary rating. The upshot? Part D prescription drug plans are increasingly focused on tracking quality and patient outcomes data to ensure the pharmacies in their preferred networks deliver the best patient care.
The Star Rating system's two medication safety measures track high-risk medications in the elderly and the appropriate treatment of blood pressure in persons with Diabetes. Its three medication adherence measures track oral Diabetes medication, cholesterol medication (statins) and blood pressure (renin-angiotensin system antagonists).
CMS also evaluates prescription drug plans on "display measures," which include metrics on drug-drug interactions, excessive doses of oral Diabetes medications and the use of atypical antipsychotics in nursing home patients. During this past year, CMS also began evaluating medication therapy management (MTM) programs by measuring the "Comprehensive Medication Review (CMR) completion rate" for all drug plans. It is expected that this measure will be added to the Star measures set in the next round of ratings.
Medicare Part D plans are now evaluating their pharmacy networks based on these Medicare Star measures. Some plans are also creating incentives for pharmacies to improve performance on these measures, while others are planning to re-formulate their preferred networks with pharmacies that perform well on the star measures. The implications for community pharmacy are significant. Never has it been more important for pharmacies to know their scores.
Retail pharmacies need to understand how they are performing on the Star Ratings measures, and benchmark how they stack up to the competition. Armed with this information, they can identify their strengths and weaknesses. And more importantly, they can implement staff training and other programs to improve scores that are lower than the national benchmark.
EQuIPP makes that possible. EQuIPP is a performance information management platform that makes unbiased, benchmarked performance data available to both health plans and community pharmacy organizations. Health plans submit their prescription claims data to the EQuIPP platform. EQuIPP then calculates the Star Ratings for each pharmacy and makes this information available to the pharmacies via a secure web site.
EQuIPP brings a level of standardization to the measurement of the quality of medication use, and makes this information accessible and easy to understand. By doing so, EQuIPP facilitates an environment where prescription drug plans and community pharmacies can engage in strategic relationships to improve the quality of medication use.
Cardinal Health is sponsoring a pilot project of EQuIPP with 600 of its retail pharmacy customers - with plans to expand the tool to a broader number of pharmacies in the coming year. Participating pharmacies can track their scores on the Medicare Star measures and get regular monthly updates on their performance. They can also see numerous benchmarks so they can compare themselves against the average scores for their managed care network, their state and the nation. Pharmacists will be able to access educational content about the Medicare Stars and quality improvement systems, and be linked to other resources for clinical quality improvement. In addition, Cardinal Health is developing additional programs to help community pharmacies improve their performance on key Star Ratings measures.
We've long known that community pharmacies serve as a lynchpin of convenient, accessible, patient-focused care in the neighborhoods and communities they serve. As health care plans continue to focus efforts on pay-for-performance and pay-for-quality programs, it's now more important than ever for community pharmacies to have access to tools that can help them prove the impact their care has on patient outcomes, and understand where they can further improve.
To learn more about EQuIPP, visit the website at www.EQuIPP.org, or contact David Nau at firstname.lastname@example.org. Due to overwhelming interest, Cardinal Health’s current pilot project with EQuIPP is at capacity. Pharmacy owners and managers who are interested in the opportunity to participate in future EQuIPP pilot projects can contact GMB-ManagedCareServices@CardinalHealth.com.