The Pharmacy Quality Alliance (PQA) is developing a standard set of pharmacy performance measures that would be appropriate for assessing pharmacy performance and for use in value-based arrangements (VBAs).

Micha Cost

Pharmacists and pharmacy teams are an essential part of the health care delivery system. As pharmacies expand patient services, they need tools to demonstrate their value. Quality measures are essential for this purpose, allowing pharmacies to monitor progress and drive improvement, while quantifying their impact on patient health. However, there is a dearth of pharmacy measures to support this need.

PQA’s work to develop pharmacy performance measures accelerated in 2019 with support from community and specialty pharmacies and in response to growing interest from Congress and the administration. Through a consensus-based and iterative process, PQA has identified and prioritized measure concepts for ­development.

These priorities are detailed in our “Pharmacy Measure Development Action Plan,” which guides our continued work to build out a pharmacy measure set suitable for payer-pharmacy arrangements. It details PQA’s progress and next steps for developing measure concepts that were prioritized based on their feasibility and usability.

PQA’s work to develop a pharmacy measure set currently includes 20 measures or ­concepts:

• Five PQA-endorsed phar­macy measures.
• 10 PQA pharmacy measure concepts in development.
• Five PQA pharmacy measure concepts prioritized for future development.

This is a multiyear initiative that requires extensive testing to evaluate and refine measure concepts, using novel data sources to assess pharmacy services for which measures have not previously existed. Distinct from health plan measures, which generally use readily available claims data, pharmacy measures depend on more complex and variable data that is captured, organized and transmitted in different ways.

The speed and scale at which PQA can test, evaluate and endorse pharmacy measure concepts depends on the broad participation and support of health plans, pharmacies and other stakeholders in the medication use process.

The five pharmacy performance measures developed and endorsed by PQA include three individual adherence measures, one composite adherence measure and one specialty pharmacy measure. These were the first pharmacy performance measures developed because they primarily rely on readily available claims data, are based on well-established approaches to measurement and address some of the most common areas of service where pharmacies currently partner with payers in VBAs.

These measures are available for use now, and we encourage pharmacies and payers to implement them in their programs. They are aligned with the PQA health plan measures that are used in the Medicare Part D Star Ratings programs, and they are good tools for health plans to incentivize or pay pharmacies in their network. I am happy to share that we are beginning to see evidence that these measures are being used in VBAs and plan quality improvement programs.

Beyond those endorsed measures, most pharmacy measure concepts prioritized by our members require data sources that are not readily available, and that brings us to the next phase of our work.

Ten additional pharmacy performance measure concepts considered the most feasible for implementation are in development now. The path and timeline for development depends on the complexity of the concept, the state of pharmacy practice and the data infrastructure for the area of service being addressed.

These 10 concepts cover:

• Hemoglobin A1c reporting, improvement and control.
• Blood pressure reporting, improvement and control.
• Continuous antidepressant medication therapy.
• Specialty pharmacy prescription abandonment rate.
• Immunization assessment and gap closure.

PQA is launching pilots this fall to assess the feasibility and usability of draft measures for hemoglobin A1c and blood pressure control and improvement. Partially supported by a small grant from the Community Pharmacy Foundation, the pilots will:

• Provide gain critical real-world information on data capture, storage and exchange in payer-pharmacy VBAs.
• Test the use of standardized pharmacy measures.
• Demonstrate pharmacies’ impact on key areas of quality in chronic disease care.

We hope to launch additional pilots soon, but we need more resources.

PQA, as a small nonprofit organization, has limited capacity to develop these measures and must rely on external resources from the industry to support the research and testing needed to assess and validate measure concepts.

There are no current national programs that incentivize the use of pharmacy performance measures in plan-pharmacy VBAs. If these measures are going to be developed and implemented, those who champion pharmacist-provided care must meaningfully invest in this work.

As the old adage goes, “If you’re not at the table, you’re on the menu.” It is not sufficient to take a passive and observational approach at this critical time. We need the active support and engagement of our members and stakeholders to ensure that we can deliver, as pressure grows for pharmacist-provided care to demonstrate its measurable value.

PQA will continue to do its part, and we have an eye toward the future.

Additional measure concepts, focused on the social determinants of health, respiratory disease management, medication reconciliation and medication therapy problem resolution, will be developed as pharmacy practice and data are standardized.

PQA’s set of standardized pharmacy measures could serve as a “pick list” or a set of options, where payers and pharmacies can select the most appropriate measures that align with the populations the pharmacy serves, the pharmacy’s ability to provide services and document necessary data and the needs the payer or VBA sponsor has identified for their members.

More information on PQA’s work to develop these measures is available on our website: pqaalliance.org/pharmacy-measures.

We appreciate the collaboration of our members and stakeholders in supporting the development of these measures. These are important tools for evaluating pharmacist-provided care and pharmacy services that can improve care and outcomes for patients, support better performance in public accountability programs and lower overall health care costs.

Micah Cost is chief executive officer of the Pharmacy Quality Alliance.