It is a bittersweet opportunity to write this Healthcare Outlook for 2021 on behalf of the Pharmacy Quality Alliance. As the outgoing chief executive officer, it has been my honor and privilege to serve PQA and its 250 organizational members since the alliance was created, initially as a public-private partnership with the Centers for Medicare and Medicaid Services. I have

Laura Cranston

enjoyed working across stakeholders including health plans, community pharmacies, health systems, technology vendors, accreditation organizations, academic institutions, prescription benefit management companies, specialty pharmacy organizations, HIT partners, and provider- and practitioner-based ­organizations.

From my earliest days with the National Association of Chain Drug Stores, and then to my work with the Institute for the Advancement of Community Pharmacy, my passion has been advancing the role of pharmacists providing frontline care. This pandemic will continue to amplify that role, especially in testing, treatment and triaging patients with chronic disease — and with patients that have been diagnosed with a COVID-19 infection. When COVID vaccines are made available in the United States, the role of pharmacist-provided services will expand very quickly.

A look back

PQA was established in 2006, the same year that the Medicare Part D Prescription Drug Benefit was implemented. As we conclude our 15th year, PQA is stronger than ever. In the initial years, PQA was known solely as a measure developer of meaningful metrics for the safe and appropriate use of medications. Since that time, PQA’s role as a measure developer has expanded, as have our roles as a health services researcher, a neutral convener and an ­educator.

A look ahead: PQA’s strategic plan for 2021

The PQA board recently approved a strategic plan that is focused on critically needed and achievable initiatives for 2021, as we continue to work our way through this pandemic and transition to new organizational leadership.

The plan is centered on three initiatives:

• Deepening our work to position pharmacists to play a meaningful role in screening, referrals and interventions to address social determinants of health (SDOH).
• Expanding and evolving PQA’s measure development process to develop new pathways to bring meaningful measures to the health care system more efficiently.
• Developing pharmacy measures that recognize the critical role of pharmacists in closing gaps in care and gaps in recommended immunizations.

First, PQA plans to deepen our work in addressing social determinants of health. We will leverage our consensus-based process to develop and endorse a standardized SDOH patient survey to support pharmacist-provided care. We also will create a PQA SDOH Resource Guide, which will detail the SDOH interventions most likely to improve the quality of medication use and where pharmacists are best positioned to provide services. PQA is positioning itself to be a leader in addressing SDOH with an emphasis on medication use and pharmacist-delivered services.

Second, PQA’s ability to develop and launch high-impact quality measures will be enhanced by designing an innovative pathway for contract-based measure development that will be in addition to our consensus-based, multi-stakeholder process. In addition, we plan to lay the foundation for a pharmacy quality rating system that can give a public rating to objectively measure the quality of community and specialty ­pharmacies.

Third, as a measure developer, for any measure to be effective and for organizations to be able to perform against a measure, we must also partner with others to solve for the need for consistent documentation of immunization services using a standardized data source. The lack of a standardized data source and infrastructure for consistent documentation may hinder the ability to effectively track completion of immunizations that require multiple doses or even a series — whether that is a COVID vaccine, an HPV series or even the two-dose regimen recommended for prevention of herpes zoster (shingles) in adults. We look forward to working with partner organizations that can help drive innovative solutions in this area.

We recognize that immunization documentation is part of a larger picture, as PQA is interested in developing a range of pharmacy measures focused on pharmacist-delivered immunization services. To reflect real-world clinical care, we need to consider all the variables that will impact vaccine administration and future measurement.

These variables include:

• Vaccine distribution, and ensuring that a diversity of health care providers, including pharmacists, will have access.
• Equity in access for all segments of the population, ensuring that underserved communities and vulnerable populations have equal access.
• Addressing the issue of vaccine hesitancy and working to effectively communicate to the public so that they understand the safety, efficacy and importance of vaccines.
• Ensuring that there are clinical guidelines in place so that patients and providers will have clear and transparent guidance on when and how vaccines should be administered.

A closing reflection

One of the elements of my position that I value the most is the relationships that have been cultivated over 30-plus years in health care association management. The health care association sector is a tight-knit and unique community, and one which I have enjoyed dedicating my career to. The ability to work with stakeholders across the health care industry — forging partnerships and establishing collaborations that will continue to expand in the months ahead as we work to emerge from this pandemic — is not easily achieved, but the need to find that common ground and to build coalitions to address our most significant challenges has never been greater. The efforts of this community of thought leaders are driving innovation and change through effective advocacy, grassroots efforts, and effectively working within the regulatory and legislative bodies at both a state and federal level.

As I read this edition each year, I am encouraged by the continued commitment of these leaders, their bold vision, their strategic initiatives and the ability to drive them in turbulent times. I look forward to my next health care adventure and to working with the individuals that I have been fortunate to partner with over the past three decades. A sincere thank you to the leaders of these organizations for your personal and professional friendship and for your support of the work PQA is engaged in to optimize health by advancing the quality of medication use.

Laura Cranston is the chief executive officer of the Pharmacy Quality Alliance.