Pharmacists need to track quality performance measures

April 23, 2015

Managed care pharmacists should track their performance on medication measures included in Medicare’s new Five-Star Quality Rating System to help guide improvement efforts.

Managed care pharmacists should track their performance on medication measures included in Medicare’s new Five-Star Quality Rating System (QRS) to help guide improvement efforts, according to David Nau, Ph.D, president of Pharmacy Quality Solutions, Inc., in Raleigh-Durham, North Carolina.

“Since medication adherence is a performance measure in the QRS, managed care plans should evaluate whether their drug benefit parameters such as deductibles, copays, and clinical edits are designed to reduce barriers to good adherence by patients,” said Nau, speaking to participants at the Academy of Managed Care Pharmacy (AMCP) meeting in a session entitled Understanding the Quality Rating System for Health Marketplaces. “The pharmacy network should also be evaluated on its performance on each measure and should be incentivized to focus its efforts on the medication-related quality measures.”

Coordinated by the Centers for Medicare and Medicaid Services (CMS), the QRS is now in place for all health plans offered through the health insurance marketplaces created by the Affordable Care Act. For plans with at least 500 enrollees during 2014, CMS is conducting a beta test in 2015 to examine the data submitted on 19 quality measures and a member survey. Beginning in 2016, CMS will post public reports showing a star rating for each qualified health plan based on these measures.

The quality measures include the following domains: clinical effectiveness, patient safety, prevention, access to care, care coordination, doctor and care, efficiency and affordability, and plan service.

Among the specific quality measures that Nau focused his talk on was the importance of tracking medication adherence, emphasizing the reduced quality of life (e.g., unnecessary disease progression and complications, reduced functional abilities) and increased cost (e.g., increased use of expensive medical resources, increased medication-related hospital admissions) associated with poor adherence.

He encouraged pharmacists to engage with their pharmacy network to track adherence such as proportion of days covered and other quality measures related to medications.

Nau also suggested that pharmacists build accountability for medication adherence, provide feedback to pharmacies on their performance, and create competition based not just on discounted fees but on quality.