AMCP urges CMS to evaluate existing quality measures for use in exchanges

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

AMCP recommends that CMS begin by evaluating the 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 ratings” quality improvement and measurement strategies under Medicare Advantage and Medicare Part D programs. The star rating system is 1 of the first national programs to use quality metrics for healthcare services. The program measures performance in 50 areas, including those that affect pharmacists and adherence.

“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,” AMCP Chief Executive Officer Edith A. Rosato, RPh, IOM, tells Formulary.

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 said. “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. The information gathered from clinician interaction with patients combined with information from quality metrics may be used by P&T committees to adjust formularies to align with patient population needs. This input, combined with clinical research data, could result in better clinical formularies.”