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The Pharmacist’s Role in Quality: A PQA Demonstration Project. Mark Conklin, PharmD, MS September 16, 2009. The Pharmacy Quality Alliance. Established in April 2006, as a public-private partnership. Drs. Mark McClellan & Carolyn Clancy - Inaugural PQA Steering Committee members.

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The pharmacist s role in quality a pqa demonstration project

The Pharmacist’s Role in Quality:A PQA Demonstration Project

Mark Conklin, PharmD, MS

September 16, 2009

The pharmacy quality alliance
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.

Pqa board of directors
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

Who s at the pqa table
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

Pqa organizational workgroup structure 2009

PQA Board of Directors


Executive Director


Grants & Sponsored



Membership &



Research & Practice


Oversight of

Demo Projects

Measure Uptake and




Education &



Research Coordinating


Quality Metrics


RFP Development


Insurers & Managed

Care Plans



Funding Sources


Prevention &



Coalitions, Employers,

Benefit Consultants



Research Priorities

Quality Measurement

Expert Panel

Pharmacist Role

In Medical Home

Public Payers

Federal Level

MTM Services

Cost of Care

Public Payers

State Level


Patient Safety

PQA Organizational Workgroup Structure 2009

Demonstration project objectives
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

Project team roles
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

Pharmacist training
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

Initial pharmacist perceptions
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

Demonstration project process flow

Rx Claims Data for the

15 PQA measures & survey

Performance Reports

Quantitative & Qualitative Feedback

Demonstration Project Process Flow

Health Plan Data Warehouse

CECity’s Lifetime™ Platform

Rite Aid Pharmacists

Collaborative Feedback & Analysis

Image pqa demonstration project

Measures grouped by category

Comparison against peers

Measure value and number of patients

  • Arrow indicates direction of change from previous period.

  • Color indicates if the change occurred in the recommended direction.

Image: PQA Demonstration Project

Image pqa demonstration project1
Image: PQA Demonstration Project

Additional information on peers

Detailed analysis over time

Measure Definition

Pharmacist feedback
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

Pharmacist feedback 1 st round
Pharmacist feedback – 1st round

5-point Likert-type scale (1 = Strongly agree to 5 = Strongly Disagree)

Pharmacist feedback 2 nd round
Pharmacist feedback – 2nd round

6-point Likert-type scale (1 = Strongly Agree to 6 = Strongly Disagree)

Pharmacist feedback barriers
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)

Best practice concepts
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

Next steps phase 2
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

Next steps targeted qi example

Patient Activation

You are now here – So now do this

You are here – So do this

Problem Res

Verbal Comm


Patient Safety

Next steps: Targeted QI Example