Specialty Pharmacy. Measures At A Glance

Transcription

1 Specialty s At A Glance Updated: 1/21/2016 Page 1 of 6

2 Specialty Mandatory s (5) Note: Mandatory measures are those measures that are a requirement of accreditation and must be reported to on an annual basis. # DM DTM Drug-Drug Interactions Call Center Performance Safe Care Health Care Mgmt Description Numerator Denominator Source This measure assesses the percentage of patients who received a prescription for a target medication during the measurement period and who were dispensed a concurrent prescription for a precipitant medication. Part A: The percentage of calls during normal business hours to the organization s call service center(s) during the measurement period that were answered by a live voice within 30 seconds. Part B: The percentage of calls made during normal business hours to the organization s call service center(s) during the reporting year that were abandoned by callers before being answered by a live customer service representative. Two or more prescriptions for a concurrent precipitant medication with 150 days between the first fill and the last fill over a 12 month period. Part A: The number of calls answered by a live customer service representative within 30 seconds of being placed in the organization's ACD call queue. Part B: The number of calls abandoned by callers after being placed in the ACD call queue and before being answered by a live customer service representative. All program participants age 18 to 75 years with no more than one gap in enrollment of up to 30 days during the measurement period who received a target medication. Total number of calls received by the organization's call service center during normal business hours during the measurement period. Enrollment ; Automatic Call Distribution (ACD) Updated: 1/21/2016 Page 2 of 6

3 Specialty # MP Dispensing Accuracy Description Numerator Denominator Source Safe Care This six-part measure and Part A: The number of drugs All drugs and products composite roll-up assesses the and products in the dispensed by the percentage of prescriptions denominator in which an organization to or on that the organization incorrect drug and/or behalf of a specific dispensed inaccurately. product was dispensed. patient during the Part B: The number of drugs measurement period. parts include: (A) and products in the Incorrect Drug and/or Product denominator that were Dispensed; (B) Incorrect dispensed to an incorrect Recipient; (C) Incorrect recipient. Strength; (D) Incorrect Dosage Part C: The number of Form; (E) Incorrect prescriptions in the Instructions; (F) Incorrect denominator that were Quantity. dispensed at an incorrect strength. Part D: The number of prescriptions in the denominator that were dispensed in an incorrect dosage form. Part E: The number of drugs and products in the denominator that were dispensed with incorrect patient instructions. Part F: The number of drugs and products in the denominator that were dispensed as an incorrect quantity. Roll up Methodology: Sum numerator parts A - F. Updated: 1/21/2016 Page 3 of 6

4 Specialty # MP MP Distribution Accuracy Turnaround Time for Prescriptions Description Numerator Denominator Source Safe Care Assesses the percentage of Part A: The number of drugs Total number of drugs prescriptions delivered to the and products dispensed with and products dispensed wrong recipient. Part A an incorrect address. by the organization to or measures the percentage of Part B: The number of drugs on behalf of a specific prescriptions mailed with an and products delivered to patient during the incorrect address; Part B the wrong location despite measurement period. measures the percentage of having the correct address prescriptions mailed with a on the package. correct address that were not delivered to the correct location. Health Care Mgmt This 3-part measure assesses the average speed with which the organization fills prescriptions, once the prescription is clean. Part A measures prescription turnaround time for clean prescriptions, Part B measures prescription turnaround time for prescriptions that required intervention, and Part C measures prescription turnaround time for all prescriptions. Part A, B, C: n1 + n2 + nx, where n1 = the number of business days to schedule delivery of prescription 1, n2 = the number of business days to schedule delivery of prescription 2 nx = the number of business days to schedule delivery of prescription x. Part A: Total number of drugs and products that arrived clean and that the organization filled during the measurement period. Part B: Total number of prescriptions that initially required intervention and that the organization filled during the measurement period. Part C: Total number of prescriptions the organization filled during the measurement period. Updated: 1/21/2016 Page 4 of 6

5 Specialty Exploratory s (4) Note: Exploratory measures are measures on the cutting edge, meaning that either the industry has not come to consensus on how to measure a particular concept or the measure is experimental or in development. In the case of exploratory measure, the organization has the option to report. # Description Numerator Denominator Source SP Fulfillment of Promise to Deliver DM Proportion of Days Covered (PDC) -- Specialty Process Assesses the percentage of prescriptions that the organization delivered on time, i.e., the percentage of prescriptions that reached patients on the date scheduled for delivery. Report separately for each book of business that is included in its accreditation. Engagement & of Care s percentage of participants 18 years and older who met the proportion of days covered (PDC) threshold of 90% during the measurement year. A separate rate is calculated for the following medications: Antiretroviral (this measure has a threshold of 90% for at least 2 medications). Number of prescriptions in the denominator that patients received on the date scheduled for delivery. The number of patients who met the PDC threshold during the measurement year. Total number of prescriptions that the organization filled during the measurement period. Members 18 years and older as of the last day of the measurement year who filled two or more prescriptions with 150 days between the first fill and the last fill, over a 12 month period. Administrative ; Claims; Enrollment Updated: 1/21/2016 Page 5 of 6

6 Specialty # PH PH Primary Medication Non- Adherence Consumer w/ Services Engagement & of Care Engagement & of Care Description Numerator Denominator Source Percentage of prescriptions for chronic medications e- prescribed by a prescriber and not obtained by the patient in the following 30 days. Assesses consumer experience based survey responses within the following domains: Staff Communication, Information about Medicine, Written Information, New Prescriptions, and About You. The number of e-prescribing transactions in the denominator where there was no pharmacy dispensing event that matched the patient and the prescribed drug or appropriate alternative during within 30 days following the e- prescribing event. The number of e- prescriptions for newly initiated during therapy for chronic medications during the measurement period for those 18 years and older as of the last day of the measurement period. Enrollment ; Electronic Clinical : N/A N/A PQA Survey Updated: 1/21/2016 Page 6 of 6