Pharmacy Outlook: Laura Cranston, PQA

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Pharmacy Quality Alliance is a national quality organization dedicated to improving medication safety, adherence and appropriate use. A measure developer, researcher, educator and convener, PQA quality initiatives support better medication use and high-quality, value-based care.

Laura Cranston

PQA was created in 2006 because prescription drug programs were a major area of health care where there was no organization or national program focused on quality improvement.

As PQA enters its 15th year, we continue to address our nation’s needs for new and different measurement, leveraging our multi-stakeholder membership and consensus-based measure development process. What do we mean when we say “new and different?” It’s best summarized by our initiatives to:

• Digitize our measures for broader, interoperable use.

• Develop pharmacy measures that assess pharmacist-provided care and pharmacy-based services, including efforts to address the social determinants of health.

• Engage patients and caregivers in new measure ­development.

• Explore new data sources that can validate and develop the next generation of measures needed in the ­marketplace.

• Demonstrate through research the impact of quality measurement on patient outcomes.

• Ensure the appropriate use of our measures and mitigate consequences of inappropriate use through stewardship.

These initiatives are driven and made possible by PQA’s continuous member engagement model. We are tackling these issues head on, guided by our diverse members’ counsel through stakeholder advisory councils, technical expert panels and one-on-one meetings. Our top three priorities as we head into 2020 are:

• Transform the PQA opioid performance measures in a manner that promotes interoperability and reporting on these measures — Section 5042 of the SUPPORT Act encourages states to develop qualified Prescription Drug Monitoring Programs (PDMPs) that would be capable of reporting on four PQA opioid performance measures. Currently, the performance measures are specified for health plan analysis, and we are working on transforming the measures to make them interoperable and able to be implemented in PDMPs. Reporting on these measures as part of a state PDMP, per Centers for Medicare and Medicaid Services (CMS) with Centers for Disease Control and Prevention (CDC) consultation, could contribute to program evaluation, continuous quality improvement in clinical processes and outcomes of care, and transparency and accountability for health plan performance ­measurement.

• Develop pharmacy measures that support community pharmacy stakeholders — Three primary drivers have led PQA to prioritize pharmacy measure work: the strong community and specialty pharmacy providers advocacy for the development of a new standard set of measures that can be used in pharmacy-plan and pharmacy-PBM agreements; the need for measures to be used according to their intended use; and the simple fact that standardized, nationally endorsed, performance measures do not currently exist for pharmacy accountability.

To meet this need, PQA is developing a standard set of measures for assessing pharmacy performance and use in accountability programs. The first phase of this work is the development of pharmacy measures adapted from existing PQA health plan measures.

This work is taking place in the short term, using administrative claims data to calculate measure rates, to accommodate the need for expedited development and testing, with endorsement consideration in January 2020.

The development of de novo pharmacy measures, a longer-term effort, will begin in early 2020 and will explore the use of pharmacy system data, lab values and other data for these additional measures.

• Evaluate the impact of measurement on patient outcomes through expanded research and demonstration initiatives — As the U.S. health care system continues to shift to value-based care, there is a strong need for meaningful quality measures that are supported and validated through high-quality research and demonstration projects. Significant gaps in health care quality and related measurement persist.

These include pharmacy services, opioid use and the social determinants of health. Additionally, there is a heightened focus on how these measures perform within emerging value-based models, including the use of quality measurement to support the pharmacist’s role in value-based care.

PQA is turning its research focus on ways that will encourage new capabilities and continuous improvements in the delivery of patient care by focusing one area of our research efforts to look at an attribution model that ensures patients are attributed to pharmacies in an appropriate way.  In doing so, PQA aims to augment care transformation initiatives that can leverage these findings to link clinical workflow innovations to standardized performance metrics through the appropriate assignment of patients to pharmacies for evaluation.

PQA is poised to help our multi-stakeholder members keep pace with health care’s evolution. From digitizing our measures to closing measurement gaps, PQA is leveraging our measure development, research, education and convening roles to improve the quality of medication use.

Laura Cranston is the CEO of Pharmacy Quality Alliance.


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