The Pharmacy Quality Alliance Optimizing Health by Advancing the Quality of Medication Use

Value-Based Contracting and Value-Based Decision Making: The Role of PQA as Measure Developer Disclaimer: PQA is in initial stages of exploring a potential role for itself in these discussions. These slides were adapted from a presentation at PQA’s Board meeting last week, where an exploratory discussion on the topic took place.

Who is the Pharmacy Quality Alliance? Mission Statement Optimizing health by advancing the quality of medication use Multi-stakeholder Membership Consensus- based Transparent Public-Private Partnership 2006 Non-profit Measure Developer

Our Fundamental Belief If you cannot measure it… you cannot monitor it. If you cannot monitor it… you cannot manage it. If you cannot manage it… you cannot improve it. This is the basis of our existence in pharmacy quality (both within the Alliance and within Solutions). This too will be the red thread of this section of the presentation. Dr. Harrington expanded on the concept that Peter Drucker articulated years earlier – if you cannot measure it you cannot manage it. Dr. H. James Harrington

What PQA can bring to the Value-Based Contracting dialogue: Develop and test new outcomes measure concepts for medications Apply rigorous research methodology to inform our approach to outcomes measurement in VBC Leverage role as a neutral intermediary, consensus-based, multi- stakeholder organization with federal/state, commercial payers, life science companies around the PQA table Measurement and scientific expertise Increase transparency and broadly disseminate our findings Delete bullet 2?

PQA Measures in the Marketplace Medicare Part D Plan Ratings Star Measures Display Measures Health Insurance Marketplace Quality Rating System Accreditation Programs URAC CPPA National Business Coalition on Health eValue8 (health plan screening & evaluation) Pharmacies & Health Plans EQuIPP Physician Offices IHA of California Community Care of North Carolina Pay-for-Performance Pharmacy Networks Inland Empire Pharmacy First CVS Health/Silverscript Medicaid Care Coordination Program Medicare-Medicaid Dual Eligible Pilot Medicaid Adult Core Measure Set Technology & Data Organizations Statewide Quality Programs New York State Department of Health Washington Health Alliance http://res.freestockphotos.biz/pictures/15/15360-illustration-of-city-buildings-in-melbourne-australia-pv.png

What is the Allocation of Risk in a Value Based Contract? RISKPayer: RISKPharma NOT RISKPayer: RISKPharma OR RISKPharma : RISKPayer

What is Valued in a Value Based Contract? Meaningful Outcomes (to patients) Clinical outcomes preferred Overall survival >>> Progression free survival Weight Loss, Smoking Cessation Quality of Life (can pose significant measurement issues) Fewer disease exacerbations requiring ED visit or urgent change in medications (e.g. MS) Fewer adverse events (GI bleed, fracture, etc) Easily Measured Claims-based preferred, EMR attainable, others available Short time horizon ideal Decrease in healthcare utilization, lower total healthcare costs?

Data Sources Claims Based – Individual Patient or Population-Based Medication Use Health Services Use Clinical Outcomes Labs Survival EMR-Based - Individual Patient or Population-Based Patient Experience (NLP – enhanced) and Patient Reported Outcomes Interview-Based – Pharmacists or Care Managers Clinical Outcomes Patient Experience (NLP – enhanced) and Patient Reported Outcomes Quality-of-Life

Could PQA Help with Standard Measure Sets? Opportunities Multi-stakeholder convener Independent, consensus-based measure developer Ability to identify feasibility challenges and test measure concepts early on Challenges: Varying clinical and financial goals in sites with contracts Varying data sources (some have EMR and not claims, etc) Varying preferences for risk Varying preferences for transparency Would pharma or payors want another player (PQA) in the space? Is a health plan looking for directional priorities or very specific measures?

PQA’s Goal: To continue to explore partnerships in VBC; based on Board-endorsed guardrails and guidelines for how/where to engage in this space, (and where not to).

Questions? Norris Turner, PharmD, PhD Vice President, Strategic Alliances and Measure Implementation NTurner@PQAalliance.org Laura Cranston, RPh CEO LCranston@PQAalliance.org