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Quality Metrics and Cost Savings

In recent years, there has been a shift in the U.S. health care system to a value-based system of care model. This model rewards providers based on the outcome of care versus the volume of patients seen. Pharmacies have also seen this shift, as they’re included in health care teams. The role of the pharmacist is to help patients with medication management to prevent adverse outcomes while working to meet clinical goals. This has led to the development of new quality metrics to measure performance and cost savings.

Assessing Performance through Metrics

The Pharmacy Quality Alliance (PQA) has focused on developing performance measures to address the safe and appropriate use of medications. These metrics have been previously used to assess the Medicare Part D prescription drug program. They are now used to assess other programs since provisions in the ACA directed the implementation of bonus payments for Medicare Advantage health plans. The quality metrics are known as the CMS star ratings program.

Pharmacy networks play a critical role by working with Medicare drug plans through the utilization of PQA’s medication use metrics. The results of these metrics account for almost half of the summary ratings for Part D stand-alone prescription drug programs and approximately 20 percent of Medicare Advantage programs.

Why are These Metrics Important for Pharmacists?

The five required metrics to be reported by pharmacists concern medication safety and adherence, including:

  • High-risk medications in seniors
  • Appropriate treatment blood pressure with diabetes patients
  • Adherence with:
    • Oral medications for diabetes
    • Cholesterol (statins) medications
    • Blood pressure medications (reinangiotensin system antagonists)

PQA’s quality metrics are being used for accreditation through the Center for Pharmacy Practice Accreditation, which will be requiring pharmacies to report several quality metrics as part of their accreditation requirements. Pharmacists will need to engage with patients and speak with physicians if adherence issues are found.

Posted in Blog on September 6th, 2017.

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