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Carla Cobb, PharmD, BCPP
Chair, CPNP Government Affairs Council

Pharmacy Quality Alliance ( ) is a non-profit, 200-member organization established in 2006. Members include professional healthcare organizations, health plans, pharmacy benefit management companies, healthcare technology businesses, state and federal agencies, academic institutions, and pharmaceutical companies. PQA develops medication-related performance measures and reporting processes. A number of PQA-developed measures are used by CMS and other health plans to provide a benchmark for comparisons across health systems. They are also used for public and health plan -mandated reporting and by pay-for-performance programs.

Measures developed by PQA that are currently in use by health plans include Proportion of Days Covered (PDC) to assess adherence to medications classes such as diabetes agents, statins, and long acting inhaled bronchodilators. Antipsychotic use in children and in persons with dementia are used to evaluate appropriate use of medications. Safety measures for opioids include the use of high doses, medications obtained from multiple providers or pharmacies, and combined use with benzodiazepines. Safety measures in the elderly include use of high risk medications and polypharmacy. There are many others beyond those mentioned.

PQA also develops quality improvement indicators which are used internally by organizations to establish quality improvement program baselines and markers of improvement. These indicators can become performance measures once there is enough information to support measure standardization. PQA measures are developed by committees of partner organization representatives and PQA staff who carefully craft and test measures over months of meetings and discussion.

In November 2017, a “Team-Based Care Workshop – Building Scalable Team-Based Models of Care” was hosted by PQA and the NCPA Innovation Center in Alexandria Virginia. The goal was to share clinical care models designed to help manage complex patients with co-morbidities. CPNP member Melissa Odorzynski, PharmD, MPH, SVP of Pharmacy Solutions at Genoa Medication Management Solutions and I presented on the role of pharmacists on the behavioral health team. Pharmacists add unique value to the healthcare team, especially those trained in caring for people with mental illnesses. It takes effort to develop successful teams – pharmacists must develop relationships with team members, communicate effectively, and provide specific solutions. To make a valuable contribution to the team pharmacists must use a standardized, evidence-based, whole-patient care process.

The conference also provided ample opportunity to engage and learn from health and pharmacy benefit plans. Plans think very differently than clinicians, focused on improving outcomes for populations. They continually struggle to align the incentives of all stakeholders with a goal of improving outcomes while lowering costs. Much of their work is focused on efforts to engage patients in preventive care, improve adherence, identify patients that most benefit from medication therapy management, employ an overabundance of data, and apply meaningful measures. But there is often a disconnect between the medical benefit and pharmacy plan silos. Although data show that optimizing medication use reduces medical spending there remains a chasm between the two. We must continue to work collectively to overcome barriers, merging pharmacy data and medical claims data, to irrefutably prove the value of pharmacy services.

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