PQA Model Demonstrates Improved Medication Adherence

San Francisco—Pharmacy Quality Alliance (PQA)’s phase 2 demonstration project, known as the Pennsylvania Collaborative, uses a model that improves patient population health by transforming pharmacy practice. Preliminary results suggest that this model could result in improved patient medication adherence and overall health by using community pharmacists.

During the AMCP meeting, stakeholders in the PA Collaborative provided an update of the project in a Contemporary Issues session titled Measuring Up: What is Around the Corner for Quality Improvement?

Members of the PA Collaborative include Highmark Blue Cross Blue Shield (BCBS), CECity, Rite Aid, and University of Pittsburgh School of Pharmacy. The official technology platform for the collaborative, Advancing Safety and Performance Improvement for Pharmacy Excellence (ASPIRE), is an Internet-based platform from CECity that provides pharmacists with a secure log-in.

Annette Boyer, RPh, vice president of business development, CECity, recapped phase 1 key accomplishments. Phase 1 established a technical approach for continuous data aggregation, exchange, and measurement; established access to Web-based performance reports inside Rite Aid for both the pharmacist and Rite Aid as a system; and created a collaborative model for quality improvement across disparate organizations that can serve as a foundation for risk share and pay for performance.

She explained that the vision for phase 2 was to move from measurement to improvement with ASPIRE’s 3-step process. Using ASPIRE, pharmacists can review performance gaps, identify performance gaps, and create improvement action plans and track progress to reach goals.

Preliminary findings of 223 pharmacies (n=117 intervention stores and n=106 control stores) included in phase 2 were presented by Janice Pringle, PhD, director, Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy.

At baseline, the intervention and control stores did not differ regarding the percentage of patients who met the proportion of days covered metric for each medication class, which included diabetes, dyslipidemia, calcium channel blockers, angiotensin-converting-enzyme inhibitors, and beta blockers. The results showed that intervention stores experienced significantly greater improvement in adherence rates than the control group stores for most categories of medications. Furthermore, changes in medication adherence in the intervention stores happened over time and accumulated. Future work will examine how well the intervention effect is sustained, if the accumulated impact results in further improvements, and whether the positive affect on adherence translates to decreased healthcare utilization and medical costs.

Maureen Bieltz, PharmD, clinical pharmacy specialist, Highmark BCBS, discussed the health plan perspective. Health plans are trying to balance cost, quality, and access, take advantage of reimbursement programs, and adapt to market changes. These changes include Medicare Advantage plans and the Centers for Medicare & Medicaid Services (CMS) Star Rating’s program. Dr. Bieltz highlighted a few of the Medicare Advantage incentives. Star Ratings will affect payment to Medicare Advantage plans wherein higher-rated plans receive higher payment. Quality bonus payments (QBPs) will be awarded on a sliding scale according to Star Ratings. Stand-alone Part D plans will have marketing advantages related to Star Ratings, but not QBPs.

The next phase of the demonstration project is the launch of the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP), a national performance measurement and benchmarking platform from which payers and pharmacies can collaborate to improve outcomes.

David Nau, PhD, senior director for quality strategies, PQA, explained that EQuIPP uses the same quality measures as those used by CMS to evaluate Medicare Part D plans. During 2012, the beta phase for the initiative will allow health plans and pharmacies in Pennsylvania, Florida, and Alabama to view quality scores and benchmarks.

EQuIPP beta phase objectives include:

• Building a network of health plans and pharmacy benefit managers to participate in EQuIPP

• Building a network of pharmacies that will participate in EQuIPP

• Expanding the EQuIPP performance dashboards to allow access to plan-level reports and benchmarks by each participating plan

• Assessing the resource requirements for EQuIPP with multiple plans and numerous pharmacies; and

• Exploring the use of a base library of intervention strategies and other resources.

Continuing his presentation, Dr. Nau said the initial focus of the EQuIPP quality measures will be on PQA measures used by CMS, which includes 3 measures of medication adherence with oral diabetes medications, statins, and blood pressure medications. The initiative will also include 3 measures of medication safety pertaining to high-risk medications in the elderly, appropriate treatment of blood pressure in diabetes patients, and drug–drug interactions.