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Pharmacy Outlook: Micah Cost, PQA

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It’s my pleasure to share insights on the future of health care as the chief executive officer of

Micha Cost

Pharmacy Quality Alliance. I assumed this role in February 2021, taking over for PQA’s founding CEO, Laura Cranston. It’s an honor to follow her legacy.

I joined PQA after serving for more than 12 years at the Tennessee Pharmacists Association (TPA), where I spent every day working for pharmacists, pharmacy team members, and stakeholders, to advance pharmacy practice through a variety of public policy initiatives. I am grateful for the many lessons I learned as TPA executive director, and those lessons have paid dividends in my new role at PQA.

PQA provided me with an incredible opportunity to expand the impact of my work. This organization is a “big-tent collaborative” providing space for our 250 member organizations to drive innovation around better patient care focused on safe and appropriate medication use. With the most diverse and broad-reaching coalition of medication use experts, PQA improves quality through stewardship of high-impact performance measures and related research, education and convening initiatives.

I’ve witnessed firsthand the impact and influence of PQA within the larger health care system. PQA celebrated 15 years of existence this year. From our early days as a public-private partnership with the Centers for Medicare and Medicaid Services (CMS) to now an independent nonprofit membership organization, PQA has remained steadfast to our mission.

Navigating the pandemic

Maintaining patient access to care has remained a top priority since the start of the COVID-19 pandemic. The acceleration of new technologies and nontraditional approaches to reach patients is one of the few bright spots of this incredibly difficult and tragic ongoing public health emergency. The shift to telehealth, at-home care and remote patient monitoring will continue to grow.

While the pandemic has been associated with a substantial decrease in the delivery of primary care and elective surgeries, patient access to medications and pharmacist-provided care was largely uninterrupted. Pharmacists and the pharmacy community remained accessible to patients through new models of care supported by numerous regulatory flexibilities. As we move forward from this pandemic, the benefits of making these regulatory flexibilities permanent will be heavily considered.

While much work remains to put this challenging chapter behind us, it’s important to note the tremendous work done by PQA member organizations.

Looking ahead to 2022

The future is as exciting as it is unpredictable. Here are a few big things that will take center stage over the next year.

  • Person-Centered Care: By increasing the weight of patient experience measures in Star Ratings, CMS signaled the importance of incorporating person-centered care throughout the health care system. While patient experience is one important measure to support patients, the pandemic has amplified significant gaps in health equity that must be addressed. One of the ways that PQA is addressing health equity is by exploring opportunities to stratify our measures to better understand and support care for underserved and at-risk populations. PQA is also working with the Patient Advocate Foundation’s Patient Insight Institute on a PCORI-funded project to convene patients and pharmacy stakeholders and develop a patient-centered outcomes research agenda to improve social determinants of health (SDOH) screenings and interventions in pharmacy settings. Every health care organization must continue to find new ways to address health equity and place patients at the center of the conversation. Further, the maturation of team-based care presents new opportunities for all providers to work together to optimize care delivery and help patients achieve their desired goals.
  • Value-Based Care Design: With the growing number of Medicare beneficiaries enrolled in Medicare Advantage programs and the ongoing push to deliver care in unique ways, there are tremendous opportunities to rethink how care is delivered. Through recent mergers and strategic partnerships, we are seeing value-based care design to increase patient access to care through convenient and accessible locations such as community pharmacies. Further, the evolution of at-home care through remote patient monitoring and telehealth will fundamentally transform the care delivery and provide new options for patients and providers to connect. This system-wide shift to value-based care presents the pharmacy community with new opportunities to work with plans to improve patient care, to close gaps and to collaboratively meet performance goals.
  • Data and Technology … a Broken Record: It’s impossible to ignore the persistent struggles within our health care system to fully leverage data and technology to optimize care. The challenges around connectivity and the lack of communication and standards between technology solutions have been exposed during the pandemic. The need for creative solutions and collaboration to address data challenges has never been more visible. Specific to quality, the growing momentum toward digital clinical quality measures (dCQMs) will play an important role in shaping the future of data interoperability and performance measurement. PQA will continue to explore strategies to digitally transform quality measures.
  • Standardized Pharmacy-Level Performance Measures: In response to calls from the pharmacy community, CMS and pending legislative proposals, PQA has completed a multiyear, collaborative stakeholder process to prioritize pharmacy performance measure concepts which can capture and attribute the care and services provided by pharmacists at the pharmacy level. These concepts are focused on reporting, improvement and control of biomarkers such as hemoglobin A1c and blood pressure, as well as closing gaps in care for preventive health conditions through immunizations. Over the next year, PQA will pursue pilot programs with member organizations and industry stakeholders to use these new measures in value-based arrangements between plans and pharmacies.
  • Evaluating Adherence at the Pharmacy Level: PQA member organizations, in December 2021, are considering endorsement of a pharmacy composite measure for the three adherence measures used in the Medicare Part D Star Ratings system. This measure is intended for use at the pharmacy level to provide a pharmacy-specific assessment of the three medication adherence measures for hypertension, diabetes and cholesterol. This composite measure addresses concerns that health plan adherence measures used in Medicare Part D have sometimes been used to assess pharmacy performance, often with insufficient denominator size. Because it was developed and tested for such use, this measure is appropriate for use in value-based plan-pharmacy agreements.
  • High-Impact Health Plan Measures: Although pharmacy performance measures are a strategic focus, health plan measures will remain a core priority within the industry. PQA will deepen our efforts in 2022 to improve the quality of medication use for high-cost and disabling illnesses. We are focused on developing or implementing health plan measures for migraine therapy and chronic lung disease, as well as convening industry stakeholders to develop strategies to improve, for example, access and adherence to oral oncolytics.
  • Sharpening the Focus on Specialty Pharmacy: Controlling the cost of prescription drugs and ensuring access remains top-of-mind for plans, providers and patients. Although prescription drug costs are a big factor in specialty pharmacy practice, the application of best practices and standardization of the patient care process across specialty pharmacies through quality measures is an ongoing area of need and opportunity. PQA member organizations were to consider in December 2021 endorsement of a pharmacy-level specialty pharmacy turnaround time measure to further standardize how specialty pharmacies are measured. This novel measure incorporates information from pharmacy systems, moving beyond claims data. It is complementary to PQA’s existing health plan specialty measures, which are focused on high-impact conditions such as multiple sclerosis, hepatitis C and HIV. PQA will continue to work with members and stakeholders to support efforts to improve medication use quality in specialty pharmacy.

A theme for 2022: consensus and connection

As I reflect on the many tremendous accomplishments of PQA during our brief 15-year history, I remain grateful for the many individuals and organizations who come together at PQA with a spirit of collaboration. The past two years have brought a dramatic shift in the health care landscape. It is critical that we work together to envision a transformative and consensus-based model for care that meets the many needs of people, especially those experiencing health inequities.

Just like the shift in health care, organizations like ours have done a great job of adapting our strategy to maintain connections with and between members. It is incumbent upon us to find new ways to facilitate meaningful connections which drive change and meet the challenges ahead.

The future is bright, and I am optimistic about the opportunity to forge new paths with our members to deliver value through improving medication use quality focused on adherence, appropriate use, safety and medication management services.

Micah Cost is the CEO of the Pharmacy Quality Alliance.


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