The Pharmacist's Role in Quality A PQA Demonstration Project (Text Version)

On September 16, 2009, Mark Conklin made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (1.4 MB) (Plugin Software Help).

Slide 1

The Pharmacist's Role in Quality: A PQA Demonstration Project

Mark Conklin, PharmD, MS
September 16, 2009

Slide 2

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.

Slide 3

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

Slide 4

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

Slide 5

PQA Organizational Workgroup Structure 2009

Image: Outline of the PQA workgroup structure for 2009 including an Education & Communication workgroup, a Research Coordinating Council, a Quality Metrics workgroup, and a set of Measure Uptake and Implementation Strategy groups.

Slide 6

Demonstration Project

Slide 7

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

Slide 8

PQA-Sponsored Demonstration Projects

Slide 9

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

Slide 10

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

Slide 11

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

Slide 12

Demonstration Project Process Flow

• Health Plan Data Warehouse
  • Rx Claims Data for the 15 PQA measures & survey
• CECity's Lifetime™ Platform
  • Performance Reports
• Rite Aid Pharmacists
  • Quantitative & Qualitative Feedback
• Collaborative Feedback & Analysis

Slide 13

Image: A sample performance report from a Rite Aid pharmacy participating in the PQA demonstration project. The pharmacy's performance on Proportion of Days Covered measures is shown along with aggregate scores for other pharmacies participating in the demonstration. Text boxes highlight the following aspects of the report:

• Measures grouped by category
• Comparison against peers
• Measure value and number of patients
• Arrow indicates direction of change from previous period. Color indicates if the change occurred in the recommended direction.

Slide 14

Image: A sample performance report for a Rite Aid pharmacy participating in the PQA demonstration project that details additional information that is provided to the pharmacist. This page of the report defines which stores the pharmacy is compared to on a regional level, the trend in their performance over time, and provides educational information on how the measures are calculated. Text boxes highlight the following aspects of this part of the report:

• Additional information on peers
• Detailed analysis over time
• Measure definition

Slide 15

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

Slide 16

Pharmacist feedback - 1st round

5-point Likert-type scale (1 = Strongly agree to 5 = Strongly Disagree)
 

Slide 17

Pharmacist feedback - 2nd round

6-point Likert-type scale (1 = Strongly Agree to 6 = Strongly Disagree)
 

Slide 18

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)

Slide 19

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

Slide 20

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

Slide 21

Consumer quality information

Image: Prototype web site for the public reporting of pharmacy quality information. Consumers can use the Find My Pharmacy function to search for pharmacies by zip code, use the Compare Pharmacies function to compare the quality information available on two or more pharmacies of interest, or use the Measure function to search by performance on a specific pharmacy measure. A map of the United States highlights the states that have information available for consumers to use.

Slide 22

Next steps: Targeted QI Example

Image: Depending on how a pharmacy scores on a specific measure, they may engage in targeted performance improvement strategies, as depicted. The example illustrates that performance improvement is a stepwise process and the intervention will depend on the pharmacy's performance on the metric of interest. The example provided is based upon potential performance as measured by a consumer experience survey.

Slide 23

Questions and discussion