Alliance fills in missing metrics to measure quality in pharmacy

August 1, 2006

Medicare part D has put a new face on pharmaceutical benefits for seniors-even with all the glitches and challenges of implementing the largest social welfare program in 40 years. It welcomed 11.5 million Medicare beneficiaries prior to the May 15, 2006, deadline, according to final Medicare prescription drug benefit enrollment data.

Medicare part D has put a new face on pharmaceutical benefits for seniors-even with all the glitches and challenges of implementing the largest social welfare program in 40 years. It welcomed 11.5 million Medicare beneficiaries prior to the May 15, 2006, deadline, according to final Medicare prescription drug benefit enrollment data.

THE EVOLUTION OF PHARMACY QUALITY

Through the fog of problems that have plagued the initiation of Part D-mix-ups on eligibility, drugs covered, reimbursement and payment-shines a beacon: the Pharmacy Quality Alliance (PQA) started in April by the Centers for Medicare & Medicaid Services (CMS). A collaborative effort among the pharmacy community, employers, health plans, consumers, physicians and the government, the alliance's primary objectives are to create a set of metrics for improving pharmacy performance and quality and reporting meaningful information to all stakeholders to improve health outcomes and reduce overall healthcare costs.

As seniors consume more and more prescription drugs under Part D, pharmacists play a larger and more critical role in their healthcare, from polypharmacy to compliance issues to generic substitution.

According to PRIME Institute for Families USA, prescription drug spending per senior in 2005 was $1,912, up from $559 in 1992. From 1992 to 2010, prescription drug spending per elderly person is projected to increase by 403%, more than twice the rate of growth in overall per senior healthcare spending, which is expected to grow by 180%. The portion of senior health spending devoted to prescription drugs is expected to increase from 7.4% in 1992 to 13.3 % in 2010.

In addition, PRIME says that the number of prescriptions per senior has jumped from 19.6 in 1992 to 34.4 in 2005.

PQA has been patterned after AQA (formerly known as the Ambulatory Care Quality Alliance) and the Hospital Quality Alliance, both of which address uniform quality performance metrics and reporting in their respective settings.

Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ), says that even though some of the PQA metrics may overlap with those of the AQA, this will prevent gaps in measurements. "It is the ideal time for PQA, which will establish a set of metrics agreed upon by all stakeholders, resulting in the safe and effective use of medications," she says. Dr. Clancy is confident that AHRQ, which does not regulate, pay for or provide care, will bring credibility and scientific rigor to the development of evidence-based metrics.

Although the launch of PQA is particularly timely in conjunction with Part D, as most participants agree, Ed Keating, vice president and general manager of Navitus Health Solutions, a pharmacy benefits manager (PBM) in Madison, Wisc., says it is long overdue.

"Pharmacists are a touch point for healthcare information. They are in a position to improve health," he says, indicating a pharmacist's ability to ensure, for example, a patient is on an asthma controller instead of only rescue medications or that a drug is being taken appropriately.

PQA is comprised of two workgroups-Quality Metrics and Reporting-and represented by diverse stakeholders, including CMS, America's Health Insurance Plans (AHIP), National Association of Chain Drug Stores (NACDS), National Community Pharmacists Assn. (NCPA), Academy of Managed Care Pharmacy (AMCP) and Express Scripts, a St. Louis-based PBM.

DEVELOPING PERFORMANCE METRICS

Larry Kocot, senior advisor to CMS Administrator Mark B. McClellan, MD, is confident that the Workgroup on Quality Metrics will fulfill its mission during the next several months without having to reinvent the wheel.

With regard to these metrics in the marketplace, Kocot comments, "Planning services are a key part of the continuum of care, and we want to optimize and highlight the value pharmacists bring to the overall healthcare equation." Common metrics resulting from PQA for Medicare will be influenced by the commercial marketplace and vice versa.

Kocot says one of the missions of PQA is to prove the value of pharmacy services so that pharmacists are appropriately compensated. "We need to align healthcare dollars and improve quality and get the biggest bang for the buck."