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ALEXANDRIA, Va. – The Pharmacy Quality Alliance (PQA) has launched two proof-of-concept pilots to implement four promising blood pressure and hemoglobin A1C pharmacy measure concepts in value-based payment arrangements (VBAs) between payers and pharmacies.
The pilots will advance pharmacy quality measurement and patient care by evaluating the impact of innovative pharmacy services on A1C and blood pressure improvement and control. One pilot consists of Kroger pharmacies partnering with Kroger Prescription Plans as the payer. The second pilot pairs a regional payer with their pharmacy network, with technology vendors supporting data exchange and reporting.
“PQA is leading the nation’s work to develop a set of standard pharmacy performance measures that would be appropriate for assessing pharmacy performance and for use in value-based arrangements,” PQA Chief Executive Officer Micah Cost, PharmD, MS, CAE, said. “Focused on hypertension and diabetes, these pilots will demonstrate the impact of pharmacist-provided care in improving chronic disease outcomes and critical areas of public health.”
These pharmacy measure concepts use a clearly defined attribution model to capture patient-pharmacy relationships and allow the use of a broad variety of data sources including prescription claims, medical claims, and clinical data from EHRs, pharmacy systems, labs, and more. As the health care system continues to move towards greater integration of data across settings, this measure design represents an important, forward-thinking approach to pharmacy measurement. The pilots will help characterize the ecosystem of data available for use in VBAs, determine measure feasibility in real-world settings, and enable PQA to refine measure specifications as needed to support standardized and accurate implementation.
“The pilots are critical for validating novel measure concepts, by providing assurance that our specifications can be consistently interpreted and applied to effectively measure the quality of pharmacist-provided care and the impact on patients,” said PQA Vice President, Quality Innovation, Lynn Pezzullo, RPh, CPEHR, CPHQ. “In addition, they will provide great insights on best practices for effective payer-pharmacy VBAs.”
PQA and the pilot participants will use the measure concepts to evaluate pharmacy services’ impact on blood pressure and A1C in 2023 and compare the results to results from 2022. The participating organizations were selected by PQA following a 2022 Request for Interest process that focused on the readiness and capabilities of payer and pharmacy partners for VBAs.
The pilots are supported in part by funding from the Community Pharmacy Foundation and Kroger Health and part of PQA’s multi-year effort to develop a set of standard pharmacy performance measures. PQA has endorsed six pharmacy measures that can be implemented now. The results of the pilots will support PQA’s work to finalize the measure concepts through its systematic, transparent and consensus-based measure development process.
