the pharmacist’s role in quality: a pqa demonstration project
DESCRIPTION
The Pharmacist’s Role in Quality: A PQA Demonstration Project. Mark Conklin, PharmD, MS September 16, 2009. The Pharmacy Quality Alliance. Established in April 2006, as a public-private partnership. Drs. Mark McClellan & Carolyn Clancy - Inaugural PQA Steering Committee members. - PowerPoint PPT PresentationTRANSCRIPT
The Pharmacist’s Role in Quality:A PQA Demonstration Project
Mark Conklin, PharmD, MSSeptember 16, 2009
The Pharmacy Quality Alliance Established in April 2006, as a public-private partnership.
Drs. Mark McClellan & Carolyn Clancy - Inaugural PQA Steering Committee members.
Consensus-based, membership alliance with over 50 members.
PQA is a nonprofit 501(c)(3) organization.
Mission: Improve the quality of medication use across health care settings through a collaborative process in which key stakeholders agree on a strategy for measuring and reporting performance information related to medications.
PQA Board of Directors•Steven Anderson, NACDS•Judy Cahill, AMCP•Laura Cranston, PQA, Inc.•Woody Eisenberg, Medco•John Feather, ASCP•William Fleming, Humana, Inc.•Karen Ignagni, AHIP•Jeffrey Kelman, CMS•David Marshall, Teva USA•Mark McClellan, Brookings•Thomas Menighan, APhA•Eleanor Perfetto, Pfizer•Bruce Roberts, NCPA•Lee Rucker, AARP•Bruce Sherman, Goodyear Tire Co.•Becky Snead, NASPA
Who’s at the PQA Table?• Pharmacy Trade Groups• Managed Care Organizations• Health Plans• AARP• Consumer Advocacy Groups• Pharmacy Practitioner Groups• PBMs• Employer Coalitions• Pharm. Manufacturers• Health IT Vendors• MTM Vendors• Chain Drug Companies• Independent Pharm. Owners• Outcomes Researchers
PQA Organizational Workgroup Structure 2009PQA Board of Directors
Executive DirectorAdministrator
DirectorResearch & Practice
Improvement
DirectorGrants & Sponsored
Programs
DirectorMembership &
Outreach
Research Coordinating Council
Quality Metrics Workgroup
Measure Uptake and Implementation
Strategies Group
Cluster Groups
Pharmacist RoleIn Medical Home
MedicationReconciliation
MTM Services
Prevention &Wellness
Cost of Care
Patient Safety
PBM
BusinessCoalitions, Employers, Benefit Consultants
Public PayersFederal Level
Public PayersState Level(Medicaid)
CommercialInsurers & Managed
Care Plans
RFP Development
Funding Sources
Research Priorities
Education &Communication
Workgroup
Oversight of Demo Projects
Quality Measurement Expert Panel
Demonstration Project
Demonstration Project Objectives
Determine resources requirements for collecting/aggregating prescription claims data and calculating the 15 PQA quality measure scores
Collection of patient experiences with pharmacy services using the PQA-sponsored survey
Generate/test models of providing pharmacy
performance reports
Get feedback from pharmacists on the reports’ accuracy, user-friendliness and value in improving quality
PQA-Sponsored Demonstration ProjectsDemo Type
(Data Source)Project Leader Partners
Health Plan Highmark BCBS CECity.com, Inc. Rite Aid
Community Pharmacy Corporation
Outcomes Pharmaceutical Health Care
Kerr Drug
Coalition of Health Plans
Pharmacy Society of Wisconsin and Wisconsin Pharmacy Quality Collaborative
State of Wisconsin Dept of Health and Family Services
United Healthcare of Wisconsin Unity Health Insurance and Group Health Cooperative of South Central
Wisconsin
Coalition of Health Plans
Purdue University School of Pharmacy
Indiana Pharmacists Alliance Indiana Health Information Exchange Regenstrief Institute
Coalition of Health Plans University of Iowa
Iowa Foundation for Medical Care, Wellmark Blue Cross and Blue Shield Iowa Medicaid Enterprise
Project Team & Roles
Highmark Blue Cross Blue Shield Data source, Project coordination & strategy
CECity (Annette Boyer) Technology vendor
Rite Aid (Rick Mohall) Pharmacy provider (n = 50)
Avatar International (David Medvedeff) Administrator, consumer experience survey
Pharmacist Training
2 hour live training sessions 90+ pharmacists Topics:
Introduction to performance measurement & reporting Specific education on the quality metrics to be used Reporting process Future & importance of focus on clinical activities and
quality improvement
Initial Pharmacist Perceptions
Excitement Means to expand the clinical role of the RPh Input into the performance measurement process Strong sense of self-efficacy to provide quality care
Concern What about claims not captured by the health plan? Will the time and resources be available to allow the
RPh to move the metrics in a positive manner? Physician acceptance of interventions Proper team approach to care of mutual patients
Demonstration Project Process Flow
Health Plan Data Warehouse
CECity’s Lifetime™ Platform
Rite Aid Pharmacists
Collaborative Feedback & Analysis
Quantitative & Qualitative Feedback
Rx Claims Data for the 15 PQA measures & survey
Performance Reports
Measures grouped by
category
• Arrow indicates direction of change from previous period.• Color indicates if the change occurred in the recommended direction.
Comparison against peers
Measure value and number of patients
Image: PQA Demonstration Project
Additional information on
peers
Detailed analysis over time
Measure Definition
Image: PQA Demonstration Project
Pharmacist Feedback
Electronic feedback survey Completed after viewing each round of the
performance reports
Pharmacist focus group Conducted 1 week after the final round of reports was
closed
Pharmacist feedback – 1st round
Statement Positive Neutral Negative
Understanding 51 21 6
Helpfulness of educational information provided with the report
46 25 7
Accurate measures of quality performance? 28 33 17
Self-efficacy for ability to impact measures 35 27 3
5-point Likert-type scale (1 = Strongly agree to 5 = Strongly Disagree)
Pharmacist feedback – 2nd round
Statement Positive Negative
Understanding 35 9
Helpfulness of educational information provided with the report
31 12
Accurate measures of quality performance? 26 17
Self-efficacy for ability to impact measures 28 10
6-point Likert-type scale (1 = Strongly Agree to 6 = Strongly Disagree)
Pharmacist feedback – Barriers
Operational barriers (i.e. lack of time, resources) Health plan/insurance barriers Physician barriers Physician office staff barriers Organizational barriers (i.e. lack of corporate
support)
Best Practice Concepts Content
Use of nationally recognized, standardized performance metrics Interventions for improvement should be linked to practice needs
Process Multi-disciplinary stakeholders Integration into workflow Meaningful reporting that is actionable, scalable
Technology Secure, web-based platform that supports customizable
dashboards to present quality data/measures to the participating pharmacies
User friendly, easy to navigate platform Scalable with ability to coordinate data from multiple sources
Next steps: “Phase 2”
Can pharmacists/pharmacies engage in meaningful performance improvement strategies?
What data is necessary to inform a new model for pharmacy reimbursement? Sustainable business model for quality care?
What mechanism(s) can be employed to provide pharmacy quality information to consumers?
Targeted QI strategies
Consumer quality information
Next steps: Targeted QI Example
You are here – So do this
You are now here – So now do this
Questions and discussion