Alliance hailed as path to measure your performance

May 22, 2006

The new Pharmacy Quality Alliance (PQA), pushed by the Centers forMedicare & Medicaid Services to develop measures of pharmacyquality, should be working toward some early proposals by late May,according its originators.

The new Pharmacy Quality Alliance (PQA), pushed by the Centers for Medicare & Medicaid Services to develop measures of pharmacy quality, should be working toward some early proposals by late May, according its originators.

On April 24 in Washington, D.C., CMS head Mark McClellan, M.D., Ph.D., told an Open Door Forum on the alliance, "The launch of the PQA is an important step toward a pharmacy business model that reports real value delivered rather than just the volume of prescriptions dispensed." He said although the initiative's primary goal will be development of performance measures, he also expects "this will lead to new pharmacy payment models to help us optimize patient outcomes at a lower cost. And, at CMS-I want to be clear-we are very interested in supporting the testing and development of those payment models."

McClellan told the forum that recent discussions about the alliance had included major pharmacy organizations, as well as AHIP, National Consumers League, National Association of State Medicaid Directors, some large employers, and others.

The alliance will have two work groups, according to Cranston. One will be on developing quality measures and the other on reporting information to consumers, pharmacists, payers, and other stakeholders. The work groups are to convene monthly by teleconference. The groups' products will be reviewed by the full alliance membership, which will meet at least twice a year. Details on current membership, work groups, and schedules, and on how groups can join will be posted at http://www.pqaalliance.org/.

McClellan said he hopes the alliance will have "breakthroughs" similar to those made by the Ambulatory Care Quality Alliance, which in 18 months has moved toward consensus measures on physician care with the involvement of health plans and many physician groups. That alliance is now ready to implement a demonstration on reforming payment to get higher-quality care at a lower cost to the system, he said.

The Hospital Quality Initiative, created several years ago, has resulted in a list of indicators for measuring hospital quality. Hospitals report their performance on these measures and CMS posts it on the agency's Web site. Hospitals are subject to reduction in their updates for Medicare reimbursement if they do not report their performance measures.

McClellan asserted that such measures can improve reimbursement to providers while reducing overall costs, because the system will not be spending as much on "unnecessary, duplicative services and on preventable and costly complications."

Bruce Roberts, R.Ph., CEO of NCPA, praised McClellan at the forum for "his recognition of the value that pharmacists can have in the healthcare system and the need to be paid for their services."

Roberts indicated the new alliance is about aligning incentives of payers, providers, and patients and ensuring pharmacists are rewarded for their work. Pharmacists, he asserted, have been relegated to being purveyors of a commodity while studies indicate there is a dollar's worth of problems for every dollar spent on the pharmacy benefit. He told the forum, "The launch of Part D, at least in my mind, gave us that opportunity to begin to really redefine pharmacy in such a way that we could begin to be recognized for the value that we bring."

In discussing the potential for change with these measures, McClellan noted, "Generic drugs are more available than ever before. Alternative therapeutic options ... are more widely available. In addition, people with chronic diseases have more knowledge that they can draw on, in terms of how to prevent complications and interactions from the multiple prescription drugs they take."