There is growing emphasis on measuring performance quality in health care, and this is more thoroughly making its way into pharmacy. Previous Tips of the Week have discussed various performance measures, including the CMS Star Ratings program. The study reviewed here was conducted in North Carolina to evaluate pharmacy in the context of true patient outcome measures, rather than on the structure and process measures often employed
Urick et al detail the lessons learned from attempting to evaluate these outcomes from a group of enhanced services pharmacies.1 The participating pharmacies were part of a community pharmacy enhanced services network (CPESN) in a demonstration project of this group that could loosely be called a practice-based research network (PBRN) in providing comprehensive MTM. The project examined adherence (through proportion of days covered) for oral diabetes medications, statins, and renin-angiotensin system antagonists, along with per member per month (PMPM) to a cost of medical care score, hospitalization score, and emergency department (ED) score, comparing the CPESN pharmacies’ performance with those of other pharmacies in North Carolina. The measures were combined into a single 11-point composite pharmacy performance score. Adherence measure scores for enhanced services pharmacies exceeded those of other pharmacies, but total scores were not significantly different unless accounting for case-mix. In other words, the outcomes approached significance when there was an adjustment for how the CPESN pharmacies were serving a less health population. he program described provides an example of a composite performance measurement system that can be used to support alternative pharmacy payment models and shows that case-mix adjustment is possible for broad outcomes such as those used in this program. As pharmacy payment models evolve, there may be value in collaboration between academics, pharmacists, and payers to bring different areas of expertise and perspectives into the performance measurement process. This program demonstrated that global outcome measurement is possible.
The lessons to be gleaned here are many and include, but not limited to the facts that enhanced pharmacy services can help improve patient adherence to medication, improved medication adherence will not always lead to better health outcomes particularly in the short-run, and that pharmacies need to be highly involved and politically active in discussions about pay-for-performance systems, making sure to include such parameters as case mix while being cautious regarding incentives or penalties for outcomes measures over which they might have limited control.
Additional information about Creating and Managing Value and Ensuring Quality in Pharmacy Operations can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.
1Urick BY, Ferreri SP, Shasky C, et al. Lessons learned from using global outcomes measures to assess community pharmacy performance. J Manag Care Spec Pharm. 2018;24:1278-1283.