The Pharmacy Quality Alliance, through a majority vote of its members, has retired six health plan performance measures.
Four of the six measures retired evaluated adherence — using the proportion of days covered as a metric — of individual diabetes medication classes, including biguanides, dipeptidyl Peptidase-4 Inhibitors, sulfonylureas and thiazolidinediones
These measures were retired primarily because PQA’s all-class diabetes adherence measure is more meaningful, because diabetes therapy often involves combination therapy. The all-class measure also is more comprehensive of available diabetes medications and can be used for monitoring individual class rates for quality improvement and monitoring.
The fifth measure, Diabetes Medication Dosing, evaluated the percentage of individuals who were dispensed a dose higher than the daily recommended dose for certain therapeutic categories of oral hypoglycemics. With very low reporting rates and little variation, the measure no longer was able to effectively distinguish good performance from bad performance and provides little room for further improvement.
The sixth measure, Use of Benzodiazepine Sedative Hypnotic Medications in the Elderly, was developed as a balancing measure for the Use of High-Risk Medications in the Elderly measure, which targets non-benzodiazepine sedative hypnotics, but not benzodiazepines. The HRM measure is being phased out of the Centers for Medicare and Medicaid Services Medicare Part D quality programs, leaving little opportunity for implementation, said PQA.
Aside from retiring these measures, PQA, through a majority vote of its members, has endorsed three new pharmacy performance measures that evaluate adherence for medication treatment of hypertension, cholesterol and HIV.
Medication adherence in these therapeutic areas remains suboptimal, PQA said, noting that pharmacists are well-positioned with knowledge and tools to support patients in improving adherence to important therapies. The measures are supported by evidence demonstrating the relationship of medication adherence with improved clinical outcomes and decreased healthcare costs.
The three measures are:
· Proportion of Days Covered: Renin Angiotensin System Antagonists (Pharmacy)
· Proportion of Days Covered: Statins (Pharmacy)
· Proportion of Days Covered: Antiretroviral Medications (Pharmacy)
"These measures represent PQA’s first step in developing a set of pharmacy performance measures to fill gaps in quality improvement,” said Laura Cranston, PQA CEO. “Standardized, nationally endorsed measures exist throughout many areas of our healthcare system; however, there is a lack of standardized measures available to assess pharmacy quality. “We will begin work this quarter to develop additional pharmacy measures that could be used in value-based care models to improve patient health.”
PQA began developing pharmacy performance measures in response to member interest. The measures provide pharmacists the opportunity to demonstrate their contributions toward high-quality, patient-centered care.
The next phase of measure development will be focused on patient health outcomes and areas of care and quality performance that pharmacists can impact. To inform this work, PQA created a Pharmacy Measure Concept Advisory Group, which will be composed of approximately 30 subject matter experts from PQA’s membership. The MCAG will assist in identifying, refining and prioritizing measure concepts for pharmacy measure development.