The Pharmacy Quality Alliance Optimizing Health by Advancing the Quality of Medication Use

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1 Optimizing Health by Improving the Quality of Medication Use The Optimizing Health by Advancing the Quality of Medication Use

2 Who is the? Mission Statement Optimizing health by advancing the quality of medication use Public-Private Partnership 2006 Non-profit Quality Measure Organization Transparent Multistakeholder Membership Consensusbased 2

3 PQA s Industry Cross-Cutting Roles Focus on Medication use measures for medication safety, adherence, and appropriate use Consensus-driven process to draft, test, refine, and endorse measures Measures fill gaps in high-priority areas of healthcare, aligning with the National Quality Strategy Measure Developer Quality Educator Promoting the use and impact of PQA measures and other healthcare quality topics Quality Workshops and Webinars, Member Education, Academic Education, Patient Education Content at the PQA Annual Meeting and PQA Leadership Summit Inform new measure development, show value of measures, promote best practices Inform new measure development, show value of measures, promote best practices Research and demonstration projects in medication use and safety Research and demonstration projects in medication use and safety Researcher Convener Fostering relationships with diverse stakeholders to advance shared goals Roundtables, Collaborations, Task Forces Networking at the PQA Annual Meeting and PQA Leadership Summit 3

4 Multi-stakeholder Membership Healthcare Quality & Standards Organizations Government 4% Agencies Associations/Foundations/ 7% Research Institutions 8% Universities/Academic Institutions 23% Pharmaceutical Industry Organizations 9% Health Plans/Health Systems/Alliances/Pharmacy Benefits Managers 13% Health Technology Solutions/Data Analytics/Consulting 23% Community Pharmacy 13% Revised May 6,

5 PQA s Measure Development Process Measure Concept Idea Measure Concept Development Draft Measure Testing Measure Endorsement Measure Update Measure Advisement Group Measure Development Teams Measure Validity Panel Measure Update Panel Task Forces PQA Member Organizations Stakeholder Advisory Panels Quality Metrics Expert Panel Risk Adjustment Advisory Panel Patient & Caregiver Advisory Panel Implementation Advisory Panel 5

6 PQA Measure Development Pipeline Medication Therapy Management Medication Therapy Problem Resolution* IZ Status Assessment within MTM* ACIP Compliance Following IZ Status Assessment* Pharmacy-Level Measures Three adherence measures: PDC-Statins, PDC-RASA, PDC-Diabetes (using pharmacy data) Patient Safety/Appropriate Treatment Inappropriate Duplicate Therapy* ADE Outcome Measures: Bleeding events* Hypoglycemic events* Initial Opioid Prescription for: Long-acting or extended-release opioids >7 days' supply >50 average daily MME Specialty Specialty Pharmacy Turnaround Time ACIP = Advisory Committee on Immunization Practices; ADE = adverse drug events; IZ = Immunization; MME = morphine milligram equivalent; MTM = medication therapy management; PDC = proportion of days covered; RASA = renin angiotensin system antagonist *In testing phase of development 6

7 PQA Measures within Medicare Part D Star Ratings 2018 Part D Star Ratings Measures Measure ID Measure Weight D12 Medication Adherence for Diabetes Medications 3 D13 Medication Adherence for Hypertension (RAS antagonists) 3 D14 Medication Adherence for Cholesterol (Statins) 3 D15 MTM Program Completion Rate for CMR 1 PQA measures significantly contribute to a plan s Star rating due to the heavy weighting of the intermediate outcome measures. 7

8 PQA Measures in the Marketplace Medicare Part D Plan Ratings Star Measures Display Measures Pharmacies & Health Plans EQuIPP Health Insurance Marketplace Quality Rating System Statewide Quality Programs New York, Washington Accreditation Programs URAC CPPA Physician Offices IHA of California Community Care of North Carolina National Business Coalition on Health evalue8 (health plan screening & evaluation) Technology & Data Organizations Medicaid Care Coordination Program Community Care of North Carolina Medicare-Medicaid Dual Eligible Pilot Medicaid Adult Core Measure Set Pay-for-Performance Pharmacy Networks

9 Measure Development Education Research Convening Stage 1 Crawl Stakeholder Advisory Panels (SAPs) Measure Endorsement Quality Forum Lecture Series Academic Affairs Committee (AAC) Internships Submit Your Idea Study Stakeholder & Participant PQA Annual Meeting; May PQA Member Connect Events Stage 2 Walk Measure Development Teams (MDTs) Task Forces (TFs) Testing Draft Measures APPE Student Pharmacist Rotation PQA Workshops Co-Investigator, Partner, Sponsor PQA Roundtables PQA Leadership Summit; November PQA Workshops Stage 3 Run Quality Metrics Expert Panel (QMEP) Implementation Advisory Panel (IAP) Measure Advisement Group (MAG) Measure Update Panel (MUP) Ambassadorship (Teach, Promote, Publish) PQA Grand Rounds Fellowships Research Coordinating Committee (RCC) PQA Lead Initiatives & Roundtables

10 PQA s New Website and Members Only Portal PQAAlliance.org Launching soon, your personalized experience awaits! New ways to engage and access PQA Member Benefits! Group forums, Online Communities & Discussions, Education

11 PQA Research Buckets Inform New Measure Development Demonstrate Measure Effectiveness Promote Best Practices 11

12 Research Portfolio Inform New Measure Development Demonstrate Measure Effectiveness Promote Best Practices Projects Year 12

13 Academic Initiatives Experiential Rotation (APPE) A unique perspective into the operations and activities of a national quality association Summer Executive Internship An 8-12 week program designed for learning about the structure and innerworkings of PQA and networking within associations Graduate Student Internship PQA CVS-Health Foundation Scholars Program Healthcare Quality Innovation Challenge Field experience for grad students in public health, business and other relevant programs Student Mentor Pairs develop a year-long research project & present results at the PQA Annual Meeting Student teams create a business proposal for solving a hot topic in healthcare 13

14 Post-Grad Opportunities & Fellowships Executive Fellowship Stratified program consisting of shadowing visits & resident exchanges Research Fellowship Development of core skillsets in research, quality metric design and implementation, and research collaboration with academic and non-academic organizations Academic Affairs Committee Educate pharmacy students in all aspects of quality, including quality improvement, quality measurement, and value-driven healthcare 14

15 Optimizing Health by Improving the Quality of Medication Use Questions? Loren Kirk Associate Director, Membership Engagement

16 Optimizing Health by Advancing the Quality of Medication Use Quality We are committed to excellence and continuous improvement. Relationships We connect diverse stakeholders to collaborate on opportunities that advance shared goals. Expertise We are the resource for the development of medication use quality measures. Influence We use our knowledge to positively impact patient care and population health. Transparency We are open, accessible, and trusted. Integrity We own and honor our commitments. Innovation We cultivate new ideas to create solutions to improve healthcare quality.

17 2018 Board of Directors Executive Committee Chair Immediate Past Chair Vice-Chair Secretary Member at-large Treasurer CEO Board Members Mary Ann Kliethermes, PharmD, Midwestern University Peter Wickersham, MSE,Express Scripts Mitch Betses, RPh, CVS Health David Medvedeff, PharmD, MBA, VUCA Health Jamie Chan, PharmD, Blue Shield of California Brian Jensen, RPh, Community Pharmacy Foundation (CPF) Laura Cranston, RPh, PQA Mike Anderson, PharmD, UnitedHealthcare Alan Balch, PhD, Patient Advocate Foundation Christie Boutte, PharmD, RPh, National Association of Chain Drug Stores Anne Burns, RPh, American Pharmacists Association Susan Cantrell, RPh, CAE, Academy of Managed Care Pharmacy Ronna Hauser, PharmD, National Community Pharmacists Association Sharon Jhawar, PharmD, MBA, CG, SCAN Health Plan Jeffrey Kelman, MD, Centers for Medicare and Medicaid Services Bhavesh Modi, RPh, Healthfirst Board Liaisons Vikki Ahern, CMS Michelle Ketcham, CMS David Nash, MD, Jefferson University Jerry Penso, MD, MBA, American Medical Group Association Vic Perini, DPh, MSc, MBA, Accredo Health Cynthia Pigg, BS Pharm, MHA, FAMCP, Gateway Health Plan Lori Reilly, Esq, Pharmaceutical Research and Manufacturers of America Will Shrank, MD, UPMC Health Plans Jason Spangler, MD, MPH, Amgen Troy Trygstad, PharmD, MBA, PhD, Community Care of North Carolina Tim Weippert, RPh, Thrifty White Pharmacy Tripp Logan, PharmD, MedHere Today Consulting Jeff Rochon, PharmD, Washington State Pharmacy Association 17

18 The PQA Team Team Member Title Laura Cranston, RPh Chief Executive Officer Jake Galdo, PharmD, MBA, BCPS, BCGP Director, Performance Measurement Laurel Glenn Project Coordinator Jacqueline Green Chief Operating Officer Lisa E. Hines, PharmD Senior Director, Measure Operations & Analytics Loren Kirk, PharmD Director, Stakeholder Engagement Charlene Lane Executive Administrator Christina McCloskey Director, Human Resources & Operations Hannah Lee-Brown, PharmD Executive Fellow Lee Holland, PharmD, MPH Research Fellow Mel Nelson, PharmD, CPHQ Associate Director, Research & Academic Affairs Irene Nsiah, MPH Director, Research & Analytics Lynn Pezzullo, RPh, CPEHR Senior Director, Quality Innovation Matthew Pickering, PharmD, RPh Director, Research & Quality Strategies Joel Montavon PharmD, MBA Director of Analytics and Performance Measurement Virginia S. Sweeter, CMP Director of Meetings Norris Turner, PharmD, PhD Vice President, Strategic Alliances & Measure Implementation 18