Leveraging Star Ratings in Medicare Within Community Pharmacies
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1 Leveraging Star Ratings in Medicare Within Community Pharmacies ASAP Conference (Kiawah, SC) Friday, January 25, 2012 Laura Cranston, RPh Executive Director YOUR PQA LOGO
2 Leveraging Star Ratings in Medicare Within Community Pharmacies Laura Cranston, Executive Director, Pharmacy Quality Alliance ACPE #: L04-P Activity Type: Knowledge-Based Following this educational presentation, attendees should be able to: 1. Describe the CMS Star Ratings program and how measures of appropriate medication use are incorporated into the program. 2. Within the CMS Star Ratings program, explain what healthcare entity is being held accountable for the measures used in this program. 3. Describe how community pharmacies can collaborate with health plans to drive improvements in quality within the Medicare Advantage program. 4. List types of interventions that are being utilized in the marketplace to drive improvements in appropriate medication use. 5. Describe the specific medication metrics used within the Star Ratings program. YOUR LOGO
3 Disclosures Laura Cranston declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. ASAP s and NCPA s education staff declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. YOUR LOGO
4 Pharmacy Quality Alliance (PQA) Established in April 2006, as a public-private partnership Consensus-based, non-profit, alliance with 100 member organizations, including: Health Plans & PBMs Pharmacies & professional associations (including NCPA) Federal agencies (CMS, FDA) Pharmaceutical mfrs Consumer advocates Technology & consulting groups Universities Mission: Improve the quality of medication management and use across health care settings with the goal of improving patients health through a collaborative process to develop and implement performance measures and recognize examples of exceptional pharmacy quality. YOUR PQA LOGO
5 PQA Medication-Related 2012 Benchmarks - Medicare Measures Patient Safety drug-drug interactions; high risk medications in the elderly Medication Adherence diabetes, hypertension, cholesterol, HIV & others Medication Therapy Management Comprehensive Medication Review (CMR) Completion Mental Health Measures antipsychotic usage in dementia population Population Health Measures Pharmacy immunization rates (in development) 5 Specialty Pharmaceutical Measures YOUR PQA LOGO
6 Where are the Measures Being 2012 Benchmarks - Medicare Used? 6 Medicare Part D Plan Ratings Star measures: medication adherence (diabetes, BP, cholesterol) medication safety (HRM, Diabetes/RASA) Display measures: 2 safety measures and 1 MTM measure URAC accreditation programs Health plan, PBM, mail/specialty pharmacy National Business Coalition on Health (NBCH) evalue8 (health plan evaluation) Integrated Healthcare Association Physician P4P programs YOUR PQA LOGO
7 Community Pharmacy: Owning the Ability to Drive Improvements in Adherence Community Pharmacy has the ability to move the needle on Adherence thru targeted interventions - Simple and Consistent Process - Easily Implemented - Practical training & education - Aligns and promotes professionalism - Robust data sources - Use of technology to scale across walls YOUR PQA LOGO
8 What is EQuIPP? Evolved from Phase I and Phase II PQA-supported demonstrations in Pennsylvania - Health plans and pharmacies can engage around quality measurement - Retail pharmacies can develop a strategy to improve on the PQA-developed measures (e.g. adherence) EQuIPP concluded its beta phase in December 2012, set to expand nationally in Beta phase was conducted in Florida, Pennsylvania, Alabama EQuIPP has evolved from a standalone initiative to be A standardized, collaborative model for quality improvement A sustainable performance information management service YOUR PQA LOGO
9 Why EQuiPP, Why Now? Medicare Star Ratings are driving attention to medication safety & adherence by MA-PDs and PDPs Increased stakes: Quality Bonus Payments, Enrollment Retail pharmacies that will be seeking accreditation will need to have capabilities for performance measurement and quality improvement Retail pharmacy and health plans can partner for quality measurement and performance improvement 9 PQA-supported demonstration in PA showed that Highmark/Rite Aid efforts led to improved medication adherence YOUR PQA LOGO
10 EQuIPP aligns with Star Ratings EQuIPP measures are from PQA: - 3 measures of medication safety - High risk medications in the elderly - Appropriate treatment of blood pressure in persons with diabetes - Drug-drug interactions - 3 measures of medication adherence - Oral diabetes medications - Cholesterol medication (statins) - Blood pressure (renin-angiotensin system antagonists) Additional quality measures can be added in the future to align with CMS, NCQA, URAC, CPPA, or other initiatives PQA
11 The Purpose of EQuIPP EQuIPP provides consistent measurement of quality in community pharmacy - Leverages quality measures created by consensus based entities (e.g. PQA) an extension of the PQA mission - Goes beyond quality dispensing and focus on quality patient care - Aligns the interests of health plans and pharmacies - Enlightens and empowers outpatient pharmacy - Proactively informs community pharmacies Measure Report Analyze Support YOUR LOGO
12 EQuIPP Services Health plans: Access to performance dashboards that display their performance and relevant benchmarks on CMS Star Ratings metrics across lines of business Visibility into the performance of their pharmacy network Analytics & insights into performance measure data Pharmacy organizations have access to performance dashboards that report their scores and relevant benchmarks across the same key quality measures EQuIPP supports multi-tier views of a pharmacy organization s performance from the individual pharmacy, through districts and regions, to the corporate overview. 12 YOUR LOGO
13 Performance Information Flow Plan 1 Plan 2 Plan 3 Data EQuIPP Reports Pharmacy 1 Pharmacy 2 Pharmacy 3 YOUR LOGO 13
14 Home Page 14 YOUR LOGO
15 YOUR LOGO
16 YOUR LOGO PQA
17 YOUR LOGO
18 YOUR LOGO
19 Beta Phase Participants Pharmacies CVS Rite Aid Walmart Walgreens Target Winn-Dixie Giant Eagle Independents Health Plans Humana Highmark BCBS Coventry Wellcare UPMC Health Plan Capital Health Plan Gateway Health Plan BCBS-Alabama HealthSpring/Bravo YOUR LOGO
20 Collaborative Research Opportunities Immediate opportunities for EQuIPP-related research include mining best practices - The EQuIPP platform, together with PQA staff will be tuned to understand different practices across unique pharmacy sites - These practices will be juxtaposed to EQuIPP results and best practices will be identified EQuIPP provides a framework to load best practice strategies - Push content and training to multiple health plans and/or pharmacies - Sharing and refining of operational strategies that create positive outcomes YOUR LOGO
21 QUESTIONS? FOR MORE INFORMATION: CONTACT LAURA CRANSTON YOUR LOGO
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