The Quality Imperative
Message to federal health plan payers from community pharmacy: We have the systems in place and the professional expertise to help millions of patients to better their health outcomes at a lower cost. Message to pharmacy from the U.S. Department of Health and Human Services and its Centers for Medicare and Medicaid Services: Prove it.
That’s the basic impetus behind the drive to measure and improve patient adherence, safe medication management and other performance benchmarks by both the private health plans that serve Medicare patients and the pharmacies they and their patients depend on. It’s become a bedrock principle for CMS through its Star ratings system for Medicare Advantage, or MAPD, and Part D prescription drug plans.
CMS’ Star ratings system was created by law in 2003 with establishment of the Part D drug benefit program. That system assigns ratings of one to five stars — five being the highest — to a variety of performance measures for every Part D or MAPD plan that serves Medicare beneficiaries.
“CMS has been evaluating health plans on Star measures for years,” said A.J. Caffentzis, SVP sales and marketing for AmerisourceBergen. “The shift in the healthcare industry to performance-based care has made a plan’s Star rating a critical factor for the community pharmacy, especially since five of the performance measures, 48% of the total Part D Star rating, are related to medication management.”
Three of those measures are related to patient adherence, and in particular, how successful a plan’s participating pharmacies are at keeping their patients on track with the medication therapy as measured by “proportion of days covered” for a prescription drug, or PDC. The other two pharmacy-driven performance benchmarks are related to patient safety and the reduction of risk, particularly for elderly patients.
Indeed, the Star rating system puts a lot of weight on the careful management of high-risk medications, or HRMs, by elderly patients. According to CMS’ rating system, the fewer high-risk meds dispensed to older Americans, the better — particularly when lower-risk alternatives are available.
“A plan’s effectiveness in proactively managing the use of HRMs is weighted heavily in the plan’s CMS Star ratings,” Express Scripts noted in a report. “Plan sponsors can achieve healthier outcomes — and a higher CMS Star rating — by strategically using advanced clinical pharmacy benefit management solutions to more effectively monitor and control the high-risk medications that members receive.”
Particularly with the advent of the National Quality Strategy, a framework from HHS for overhauling the nation’s health system to make it more cost-effective and outcomes-driven, the quality and performance measurement efforts embodied in the Star ratings system are key to pharmacy’s future. The reason: retail pharmacy’s ability to participate in the new healthcare system that is emerging from the chaotic soup of health reform, pay-for-performance reimbursement trends and evidence-based medicine will depend on its ability to benchmark and measure pharmacists’ success in providing safe and effective medication therapy to millions of patients and improving adherence rates — and demonstrating improved patient outcomes as a result of those efforts. That benchmarking effort also depends on communicating those quality and safety performance metrics to health plans and payers.
“With the shift to value-based purchasing, the U.S. healthcare system faces significant transformation,” said Robert McMahan, president of United Drugs, a major member-owned pharmacy services administration organization with roughly 1,300 independent pharmacies as members. “Payers are navigating the complexities of a new reimbursement environment, and independent pharmacists must be able to show value by driving quality metrics and positive outcomes.”
Laura Cranston, executive director of the Pharmacy Quality Alliance, agreed. “We are moving to a value-based [healthcare] model, and this model relies on performance measures,” she said. “Performance measures and adoption of measures is about driving value and making value part of the healthcare equation — being able to measure it, and also being able to hold people accountable. So measures are being created to hold entities accountable.”
It’s essential, Cranston told DSN Collaborative Care, that chain and independent pharmacies adopt a system of tracking and communicating performance and quality metrics, and align those metrics with those of the health plans and PBMs they do business with. And that’s particularly true given the increasing reliance by CMS on its Star rating system as a basis for performance-based payments to MAPD and Part D health plans. Also lending urgency to the adoption of performance metrics: the move toward pay-for-performance incentive payments that go directly to pharmacies.
“Pharmacists … want to be recognized [by law] as a healthcare provider. If they are, they are able to bill directly to … payers in government and elsewhere,” Cranston said. However, she added, “you are not going to be recognized as a healthcare provider unless you’re willing to accept accountability, because every healthcare provider recognized by CMS as a distinct healthcare provider has performance measures of accountability. And performance measures are going to be part and parcel of every federal- or state-funded program.”
Formed in 2006, PQA is a public-private alliance that has taken a lead role in the development of medication-related quality measures for evaluating health plans, pharmacy benefit managers and pharmacies. Its goal: To “improve the quality of medication management and use across healthcare settings with the goal of improving patients’ health through a collaborative process to develop and implement performance measures,” the organization said. That vision also means recognizing “examples of exceptional pharmacy quality.”
The group’s new vision statement expands on its original mission, which also includes “reporting meaningful information to consumers, pharmacists, employers, payers and other healthcare decision-makers to help make informed choices, improve outcomes and stimulate the development of new payment models.”
PQA’s performance and quality metrics have been endorsed not only by CMS and its Star rating system for Medicare Advantage and Medicare Part D plans, but also by the National Quality Forum; the National Committee for Quality Assurance; the National Council for Prescription Drug Programs; the National Business Coalition on Health; and URAC, a major independent healthcare accrediting agency. Inland Empire Health Plan also adopted its quality and performance measurement standards for a major pay-for-performance demonstration project in California that involved pharmacies.
PQA’s membership comprises more than 130 organizations, including virtually every pharmacy advocacy group, including the American Pharmacists Association, the National Association of Chain Drug Stores and the National Community Pharmacists Association; retailers Walgreens, CVS Caremark, Rite Aid, Walmart, Target, Kroger and Safeway; and dozens of pharmaceutical manufacturers, pharmacy benefit management firms, colleges of pharmacy, health plans and government agencies.
“We’re moving to a value-based healthcare system where providers, hospitals and other organizations are going to be paid based on their ability to both generate positive outcomes and control costs,” said Anne Burns, VP professional affairs for APhA. “This is an opportunity for pharmacists to get on board with: How can I help a healthcare entity; how can I help a physician; how can I help an ACO meet their quality measures?”
What’s more, APhA noted, “pharmacies’ performance on Star measures may determine if they’re eligible for a bonus payment, and also may determine whether that plan includes the pharmacy in a preferred network.”
David Nau, president of Pharmacy Quality Solutions, added, “if you try to align the financial incentives for better quality, you ultimately get people to produce better quality because they have that financial incentive to do so.” Community pharmacy, he said, “is really one of the last entities to be folded into this value-driven model.”
PQS has developed a national platform for medication-related quality measurement, benchmarking and collaboration among health plans, PBMs and pharmacies that aggregates and disseminates data from all those sources to measure the quality of medication utilization, including adherence and patient safety processes through medication management. The system is called Electronic Quality Improvement Platform for Plans and Pharmacies, or EQuIPP.
The need to adopt performance and quality metrics will only increase, according to Nau’s company. “The healthcare system is trending toward a proliferation of value-based purchasing arrangements in which payment for services is tied not just to a set fee per service, but also to an incentive for providers who can demonstrate improvements in patient care,” PQS noted in a statement. “One of the strongest drivers for this change is the Centers for Medicare and Medicaid Services’ Star Ratings for Parts C/D and ‘quality bonus payments’ for Medicare Advantage plans. Medicare plans have millions of dollars at stake relative to their Star ratings.”
Given their position at the front lines of community-based accessible care — and at the nexus where the needs of patients intersect with the cost-saving demands and quality performance objectives of health plan payers and pharmacy benefit managers — pharmacists have a big role to play in the shift to performance-based payment systems, PQS asserted. They’re also essential to the success of the Medicare Part D plans that provide drug benefits to millions of seniors.
“Pharmacists have long been a care provider with the expertise and accessibility necessary to influence positive changes in patients’ medication use,” PQS said. “The traditional fee-for-service financial arrangements that drive most, if not all, payment for pharmacy services does not foster an environment where pharmacists can be optimally engaged in large-scale continuous quality improvement efforts outside of those that directly impact the accurate and timely dispensing of medications.”
Among other pharmacy providers, all three of the nation’s top drug wholesale companies — McKesson, AmerisourceBergen and Cardinal Health — have adopted the EQuIPP performance measurement platform from Pharmacy Quality Solutions and PQA, and have made it available to the thousands of independent and franchised pharmacy members they supply and service.
AmerisourceBergen, for instance, announced a major initiative in December 2013 to align its network of 3,200 Good Neighbor Pharmacy owner-operators with CMS’ Star measure improvement goals. The initiative includes an agreement with Pharmacy Quality Solutions to bring EQuIPP to GNP members, and to offer those members an educational series in dozens of locations around the United States on CMS’ Star measuring system, and on how pharmacies can improve their rating in partnership with the health plans whose patients they serve.
Gatsby men’s grooming brand expands distribution in Ricky’s NYC stores
NEW YORK — Japan’s Gatsby, a men’s grooming brand in Asia, is moving forward with the U.S. expansion of its hair wax line, Moving Rubber, by increasing its presence within Ricky’s NYC locations.
After two months of successful testing in five Manhattan Ricky’s NYC locations, the brand can now be found on the shelves of all Ricky’s NYC stores, including Ricky’s NYC stores in Miami.
“As the destination for all things cult beauty, Ricky’s NYC jumped at the chance to carry a fan favorite like Gatsby. Our customers love discovering new, unique international brands — especially when it comes to hair products, and we are more than happy to oblige them. This is truly the beginning of a stylish partnership,” stated Lorne Lucree, director of marketing at Ricky’s NYC.
The Gatsby Moving Rubber hair wax line, with 73% market share in the men’s hair wax category, recorded No.1 sales again in Japan in 2013, the brand stated. Since its launch in 2006, more than 100 million units of Moving Rubber were sold to more than 10 countries and regions in Asia.
From casually arranged to elaborative hairstyles, Gatsby promises any desired look to be created easily and by anyone with the use of the Moving Rubber product. Once Moving Rubber is applied to the hair — preferably dry — rearranging the style throughout the day is made easy due to the “moveability” and hold of the product.
The line includes Spiky Edge for strong holding power that keeps hair spiked all day; Wild Shake to create a causal messed-up look; Air Rise to create volume with a light, soft finish; and Cool Wet to maintain the desired hold with a cool wet look.
Fitbit app to be pre-loaded on the new HTC One (M8) smartphone
SAN FRANCISCO — Fitbit on Wednesday announced that its activity and sleep trackers now sync directly with 44 Android and iOS devices, up from 26 in early January. In addition, to bring health and fitness tracking to even more users, Fitbit also announced Wednesday that the free Fitbit app will be pre-loaded on the new HTC One (M8), allowing users to track their activity with just their smartphone.
“By combining the most product choices for health and fitness tracking with compatibility to the largest number of devices, users can choose what best fits their lifestyle and have better success in reaching their health and fitness goals,” stated James Park, CEO Fitbit.
Expanding health and fitness tracking to even more people, Fitbit and HTC announced a partnership this week where the Fitbit app will come pre-loaded on the new HTC One (M8) device in select regions and is available to HTC One (M8) owners anywhere that Fitbit can be downloaded from the Google Play store. The Fitbit app allows users to track basic activity, including steps taken, distance travelled and calories burned. They can set fitness goals and then see their achievements right on their HTC BlinkFeed home screen and lock screen. By combining HTC’s power-saving sensor hub with the power and accuracy of the Fitbit app, users can track their fitness and stay motivated with just their smartphone. They can also challenge, compete or encourage other users who have a Fitbit tracker3 or are utilizing the app on their phone. As the top downloaded app in its category, Fitbit has a large community, helping users stay motivated by sharing and competing with anyone that has the Fitbit app.
Instant access to up-to-date data on mobile devices makes it easy to integrate fitness into everyday life, Fitbit noted. Fitbit’s activity trackers sync via Bluetooth 4.0 to the widest variety of mobile devices across both Android and iOS platforms. The Fitbit app is the top downloaded app for connected fitness devices on both Google Play and Apple iTunes stores.
Android users are rapidly embracing the Fitbit app, with more than 1 million downloads from the Google Play store and a 4-star rating. In a recent study by app analytics firm Distimo, the free Fitbit app accounted for 83% of device installs on Google Play among top fitness tracker apps. The Distimo study also verified that Fitbit dominates companion apps for fitness trackers competition on iOS with 72% of downloads.
Regardless of platform, with direct syncing to the free Fitbit app, users can see real-time activity stats from Fitbit’s family of activity and sleep trackers, which measure everything from steps taken, distance travelled, calories burned, active minutes and floors climbed to sleep quality. Fitbit’s mobile and online tools are proven to boost motivation (users with one or more friends are 27% more active) with features like notifications, badges and leaderboards; reach goals faster with a little friendly competition using the cheer, taunt and direct message functions with friends. Fitbit users take 43% more steps with Fitbit products, the company reported.