AMCP seeks quality plan for exchanges

Quality rating processes will begin in 2016 for insurance exchanges, and iindustry groups recommend using current measures

The Academy of Managed Care Pharmacy (AMCP) recommends that the Centers for Medicare and Medicaid Services (CMS) evaluates existing national quality health measures before implementing quality metrics in state health insurance exchanges starting in 2016.

“AMCP’s recommendations seek to align medication quality measures with other healthcare measures using tested metrics approved and adopted by various standard setting organizations to provide healthcare professionals, including pharmacists, involved with patient care to receive a more complete perspective on the patient’s health status and targeted goals,” says AMCP Chief Executive Officer Edith A. Rosato.

The American Hospital Assn. sent a similar letter last month, indicating that exchange quality measures should align with existing federal measures to simplify reporting and reduce the administrative burden for providers. The organization also believes that health plan and hospital measures should be balanced and calls for evaluation of health plans’ ability to link patients to services.

AMCP recommends that CMS begin by evaluating the Medicare star ratings program to select measures that improve quality, while eliminating those that do not, before incorporating these measures in the exchanges. AMCP also suggests that CMS consider the measurements used to evaluate accountable care organizations (ACOs), patient-centered medical home (PCMH) models, and other innovative delivery systems when developing measures for use in the exchanges.

Academy members have experience with the star quality improvement and measurement strategies under Medicare Advantage and Medicare Part D programs. The star rating system is one of the first national programs to use quality metrics for healthcare services, measuring performance in 50 categories.

Proper medication utilization is critically important to health quality and outcomes, as recently noted by the Congressional Budget Office’s report, “Offsetting the Effects of Prescription Drug Use on Medicare’s Spending for Medical Services.”

“This report finds that increased spending in prescription drugs may lower cost in other areas,” Rosato says. “Quality measures provide a benchmark of patient medication utilization, but monitoring and oversight must occur through regular interactions with the healthcare team, including pharmacists, to help achieve desired outcomes.”

She says the information gathered from the point of care combined with reported quality data could be used to adjust formularies to align with population needs. The result could be improved formularies.