Pharmacy measures and policy considerations for pharmacy practice

PQA is Develop a set of standard pharmacy performance metrics Suitable for pharmacy performance appraisal and for use in value-based arrangements (VBAs). Our work to develop pharmacy performance metrics accelerated in 2019 at the request of PQA member organizations, particularly community and specialty pharmacies, and in response to increased interest from Congress and the administration.

Through our process based on consensus and iteration, PQA has identified and prioritized 20 metrics or concepts at different stages of the PQA metric development lifecycle: five measures have been adopted, 10 measurement concepts are currently in development, and five measurement concepts have been prioritized for future development.

Pharmacy Metrics: A New Kind of Quality Metric

At first glance, the development of pharmacy performance metrics may not seem unusual. However, the success of PQA is noteworthy given the many challenges and complexities of developing feasible, reliable, and usable pharmacy performance metrics given the significant differences in the level of attribution, intended use, data sources, and population sizes compared to health plan metrics.

Health plan measures rely primarily on readily available claims data. Accessing, testing and determining the feasibility and usability of measures based on administrative claims data is a well-established and generally predictable process. In contrast, there are many unknowns in the development of pharmacy procedures, which depend on identifying, accessing, and standardizing complex and changing data that is captured, organized, and transmitted in different ways.

These are significant development challenges, but PQA has the experience and expertise to continue our successful work as the only national consensus-based organization that develops health plan and pharmacy measures for drug use.

Besides the challenges of developing procedures, there are several important policy issues that can affect pharmacists’ ability to positively influence the quality of patient care through the use of pharmacy performance measures.

Policy considerations for improving quality through pharmacy

1. Immunization Authority – PQA gave priority to pharmacy performance measurement concepts related to immunizations. To support pharmacists’ ability to assess patients’ immunization needs and successfully fill gaps in immunization-related care, immunization authority must be consistent across states and locations of pharmacy practice. State-specific variables and private practice It impairs pharmacists’ ability to move the needle in relation to the outcomes of care related to immunizations. These variables include limiting pharmacists’ authority to order and administer vaccines, restricting the types of vaccines authorized, restricting vaccine administration by pharmacy technicians and student pharmacists, and restricting access based on patient demographics such as age.

Uniform harmonization of public health policies across states and practice locations, including authorizing pharmacists to order and administer all approved or FDA-approved vaccines through an independent prescribing authority, population health protocols, or collaborative practice agreements, allowing pharmacy technicians and student pharmacists to administer immunizations and Removing patient-specific restrictions such as age, would greatly enhance the ability of pharmacists to improve the quality of care for patients through immunization services.

2. Therapeutic exchange The PQA endorsed four pharmaceutical measures related to drug adherence and prioritized new pharmacology measurement concepts related to drug management services. Improved medication management is essential for patients with diabetes, high blood pressure, asthma, COPD, mental health, and other chronic conditions.

A policy change that can support pharmacists’ success in providing drug management services is licensing Therapeutic exchange Among the medications are among the drug classes and diagnosed conditions. Therapeutic exchange, which may include initiating orders, prescribing and selecting the most appropriate drugs within drug classes and disease states—and deprescribing unnecessary, duplicate, or suboptimal drug treatments—enables pharmacists, as drug experts, to ensure that patients are on the best possible treatments.

Establishing a policy that allows for therapeutic exchange by pharmacists will greatly enhance the ability of pharmacists to improve patient outcomes and could lead to better quality of care. Furthermore, the therapeutic exchange will ensure that pharmacists work in line with the shared goals of patients, health plans, payers, and other members of the healthcare team.

3. Pharmacy care and services Many of PQA’s 14 priority drug management measurement concepts focus on the reporting, improvement, and control of clinical biomarkers of hemoglobin A1C and blood pressure. As evidenced by the pharmacy response to the COVID-19 pandemic, pharmacies have established their role as accessible and convenient locations for patients to receive care and services. Recent expansions in pharmacist-led testing and treatment practice models At the state and federal level, pharmacists are able to perform a wide range of patient care services.

In addition, the number of pharmacies with CLIA exemptions has increased exponentially over the past few years, with a Content Management System (CMS) reporting this 26372 pharmacy You have active CLIA exemptions, second only to physicians’ offices. These policy developments increasingly position pharmacies as ideal locations for convenient and effective access to care and services and to support quality improvement efforts.

4. Data infrastructure and interoperability Pharmacy performance metrics require the use of innovative technology solutions to capture and transmit data beyond just prescription claims and information distribution. Ongoing challenges regarding data accuracy, completeness and interoperability across care systems, lack of standardization and inability to share information between patients, providers, plans and payers in a timely manner, continue to cause disruptions in care.

When aligned across quality-based programs and providers, quality metrics reward quality improvement, including those using pharmacy measuresIt has the ability to inform and support better quality of care. Although this is certainly an oversimplification of the many complexities of data and technology, quality programs that align incentives through value-based arrangements between plans and providers, including pharmacists, can promote quality improvement and a higher level of quality of care. for patients.

What’s Next?

The General Authority for Qualifications remains committed to this important effort, and now is the time to expand the authority’s pharmacy measurement development capacity. However, our ability to deliver with the necessary speed and scope is highly dependent on the support and participation of our members and stakeholders. Additional support from PQA stakeholders is needed to allow us to submit and push for approval of multiple pharmaceutical measures by the end of 2024, providing the core of a set of nationally recognized standard pharmacy performance metrics.

PQA will meet with stakeholders in November 2022, prior to the PQA Leadership Summit, to seek additional input on high-priority pharmacology measurement concepts. These concepts will provide updates to our plan that respond to rapid changes in pharmacy practice, healthcare delivery and trends in value-based arrangements. Ongoing stakeholder input is critical to ensuring that our plan continues to focus on relevant current priorities and address stakeholder needs.

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