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

2. 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.

3. 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

4. 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

5. 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?

6. 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

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

8. 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?

9. 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

10. 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?

11. 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).

12. Questions?
Norris Turner, PharmD, PhD Vice President, Strategic Alliances and Measure Implementation Laura Cranston, RPh CEO