The Pharmacists Role in Quality: A PQA Demonstration Project

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The Pharmacists Role in QualityA PQA
Demonstration Project

• Mark Conklin, PharmD, MS
• September 16, 2009

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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.

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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

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Whos 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

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PQA Organizational Workgroup Structure 2009
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• Demonstration Project

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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

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PQA-Sponsored Demonstration Projects
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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

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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

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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

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Demonstration Project Process Flow

• Health Plan Data Warehouse
• CECitys Lifetime Platform
• Rite Aid Pharmacists
• Collaborative Feedback Analysis

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Image PQA Demonstration Project

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Image PQA Demonstration Project

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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

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Pharmacist feedback 1st round
5-point Likert-type scale (1 Strongly agree to
5 Strongly Disagree)
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Pharmacist feedback 2nd round
6-point Likert-type scale (1 Strongly Agree to
6 Strongly Disagree)
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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)

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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

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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

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Consumer quality information
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Next steps Targeted QI Example
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• Questions and discussion