1. The Pharmacist’s Role in Quality: A PQA Demonstration Project Mark Conklin, PharmD, MS September 16, 2009

2. The Pharmacy Quality Alliance Established in April 2006, as a public-private partnership.  Drs. Mark McClellan & Carolyn Clancy - Inaugural PQA Steering Committee members. Consensus-based, membership alliance with over 50 members. PQA is a nonprofit 501(c)(3) organization. Mission: Improve the quality of medication use across health care settings through a collaborative process in which key stakeholders agree on a strategy for measuring and reporting performance information related to medications.

3. PQA Board of Directors Steven Anderson, NACDS Judy Cahill, AMCP Laura Cranston, PQA, Inc. Woody Eisenberg, Medco John Feather, ASCP William Fleming, Humana, Inc. Karen Ignagni, AHIP Jeffrey Kelman, CMS David Marshall, Teva USA Mark McClellan, Brookings Thomas Menighan, APhA Eleanor Perfetto, Pfizer Bruce Roberts, NCPA Lee Rucker, AARP Bruce Sherman, Goodyear Tire Co. Becky Snead, NASPA

4. Who’s at the PQA Table? Pharmacy Trade Groups Managed Care Organizations Health Plans AARP Consumer Advocacy Groups Pharmacy Practitioner Groups PBMs Employer Coalitions Pharm. Manufacturers Health IT Vendors MTM Vendors Chain Drug Companies Independent Pharm. Owners Outcomes Researchers

5. PQA Organizational Workgroup Structure 2009 PQA Board of Directors Executive Director Administrator Director Research & Practice Improvement Director Research & Practice Improvement Director Grants & Sponsored Programs Director Grants & Sponsored Programs Director Membership & Outreach Director Membership & Outreach Research Coordinating Council Research Coordinating Council Quality Metrics Workgroup Quality Metrics Workgroup Measure Uptake and Implementation Strategies Group Measure Uptake and Implementation Strategies Group Cluster Groups Cluster Groups Pharmacist Role In Medical Home Pharmacist Role In Medical Home Medication Reconciliation Medication Reconciliation MTM Services Prevention & Wellness Prevention & Wellness Cost of Care Patient Safety PBM Business Coalitions, Employers, Benefit Consultants Business Coalitions, Employers, Benefit Consultants Public Payers Federal Level Public Payers Federal Level Public Payers State Level (Medicaid) Public Payers State Level (Medicaid) Commercial Insurers & Managed Care Plans Commercial Insurers & Managed Care Plans RFP Development Funding Sources Research Priorities Education & Communication Workgroup Education & Communication Workgroup Oversight of Demo Projects Oversight of Demo Projects Quality Measurement Expert Panel Quality Measurement Expert Panel

6. Demonstration Project

7. Demonstration Project Objectives Determine resources requirements for collecting/aggregating prescription claims data and calculating the 15 PQA quality measure scores Collection of patient experiences with pharmacy services using the PQA-sponsored survey Generate/test models of providing pharmacy performance reports Get feedback from pharmacists on the reports’ accuracy, user-friendliness and value in improving quality

8. PQA-Sponsored Demonstration Projects Demo Type (Data Source) Project Leader Partners Health PlanHighmark BCBS CECity.com, Inc. Rite Aid Community Pharmacy Corporation Outcomes Pharmaceutical Health Care Kerr Drug Coalition of Health Plans Pharmacy Society of Wisconsin and Wisconsin Pharmacy Quality Collaborative State of Wisconsin Dept of Health and Family Services United Healthcare of Wisconsin Unity Health Insurance and Group Health Cooperative of South Central Wisconsin Coalition of Health Plans Purdue University School of Pharmacy Indiana Pharmacists Alliance Indiana Health Information Exchange Regenstrief Institute Coalition of Health Plans University of Iowa Iowa Foundation for Medical Care, Wellmark Blue Cross and Blue Shield Iowa Medicaid Enterprise

9. Project Team & Roles Highmark Blue Cross Blue Shield  Data source, Project coordination & strategy CECity (Annette Boyer)  Technology vendor Rite Aid (Rick Mohall)  Pharmacy provider (n = 50) Avatar International (David Medvedeff)  Administrator, consumer experience survey

10. Pharmacist Training 2 hour live training sessions 90+ pharmacists Topics:  Introduction to performance measurement & reporting  Specific education on the quality metrics to be used  Reporting process  Future & importance of focus on clinical activities and quality improvement

11. Initial Pharmacist Perceptions Excitement  Means to expand the clinical role of the RPh  Input into the performance measurement process  Strong sense of self-efficacy to provide quality care Concern  What about claims not captured by the health plan?  Will the time and resources be available to allow the RPh to move the metrics in a positive manner?  Physician acceptance of interventions  Proper team approach to care of mutual patients

12. Demonstration Project Process Flow Health Plan Data Warehouse CECity’s Lifetime ™ Platform Rite Aid Pharmacists Collaborative Feedback & Analysis Quantitative & Qualitative Feedback Rx Claims Data for the 15 PQA measures & survey Performance Reports

13. Measures grouped by category Arrow indicates direction of change from previous period. Color indicates if the change occurred in the recommended direction. Arrow indicates direction of change from previous period. Color indicates if the change occurred in the recommended direction. Comparison against peers Measure value and number of patients Image: PQA Demonstration Project

14. Additional information on peers Detailed analysis over time Measure Definition Image: PQA Demonstration Project

15. Pharmacist Feedback Electronic feedback survey  Completed after viewing each round of the performance reports Pharmacist focus group  Conducted 1 week after the final round of reports was closed

16. Pharmacist feedback – 1 st round StatementPositiveNeutralNegative Understanding51216 Helpfulness of educational information provided with the report 46257 Accurate measures of quality performance? 283317 Self-efficacy for ability to impact measures 35273 5-point Likert-type scale (1 = Strongly agree to 5 = Strongly Disagree)

17. Pharmacist feedback – 2 nd round StatementPositiveNegative Understanding359 Helpfulness of educational information provided with the report 3112 Accurate measures of quality performance? 2617 Self-efficacy for ability to impact measures 2810 6-point Likert-type scale (1 = Strongly Agree to 6 = Strongly Disagree)

18. Pharmacist feedback – Barriers Operational barriers (i.e. lack of time, resources) Health plan/insurance barriers Physician barriers Physician office staff barriers Organizational barriers (i.e. lack of corporate support)

19. Best Practice Concepts Content  Use of nationally recognized, standardized performance metrics  Interventions for improvement should be linked to practice needs Process  Multi-disciplinary stakeholders  Integration into workflow  Meaningful reporting that is actionable, scalable Technology  Secure, web-based platform that supports customizable dashboards to present quality data/measures to the participating pharmacies  User friendly, easy to navigate platform  Scalable with ability to coordinate data from multiple sources

20. Next steps: “Phase 2” Can pharmacists/pharmacies engage in meaningful performance improvement strategies? What data is necessary to inform a new model for pharmacy reimbursement?  Sustainable business model for quality care? What mechanism(s) can be employed to provide pharmacy quality information to consumers? Targeted QI strategies

21. Consumer quality information

22. Next steps: Targeted QI Example Patient Safety Empathy Verbal Comm Problem Res Patient Activation You are here – So do this You are now here – So now do this

23. Questions and discussion