It’s no secret that performance on a variety of measures can have a significant impact on community pharmacies, especially when it comes to a store’s bottom line. A continued focus in 2019 on performance and quality will see payers seeking to improve health care quality and outcomes while reducing spending.
Continuations for 2019:
Although the specific quality measures that pharmacies are evaluated on is payer-specific, the focus will largely remain on the following categories:
- Cholesterol (statin) proportion of days covered (PDC) aka adherence.
- Renin-angiotensin system antagonist (RASA) PDC.
- Diabetes (non-insulin meds) PDC.
- Statin use in persons with diabetes (SUPD).
- Comprehensive medication review (CMR) completion rate.
New and Notable in 2019:
Statin Use in Persons with Diabetes (SUPD) Becomes a Part D Star Measure
Previously a display measure, Statin Use in Persons with Diabetes (SUPD) is now a Medicare Part D Star measure. Performance on this measure will factor into a plan’s Star rating.
What this means for pharmacies: While some payers have evaluated pharmacy performance on this measure for some time, including factoring into direct and indirect remuneration (DIR) fees and pay-for-performance programs, they will likely be taking a closer look in 2019.
Statin Therapy for Patients with Cardiovascular Disease (SPC) is a Part C Measure
Measures the percentage of males 21 to 75 years of age and females 40 to 75 years of age who were identified as having clinical atherosclerotic cardiovascular disease and were dispensed at least one high or moderate intensity statin medication during the measurement year.1
What this means for pharmacies: While not a contributor to DIR fees at this time, payers will likely be monitoring pharmacy performance in this area and may begin factoring it into pay-for-performance programs.
What Should I Do?
The Clinical Performance Dashboard was developed exclusively for EPIC Pharmacy Network, Inc. (EPN) members. It is designed to quickly and easily provide pharmacies with essential performance information. Pharmacies can view their performance at a glance for PrescribeWellness, EQuIPP, OutcomesMTM, and Mirixa; and, most importantly, are provided support on how to improve.
Interested in learning more about this exciting performance tool or viewing a demo? Contact the Clinical Programs Team online or at 800-965-EPIC (3742).
References:
- PQS Summary of Quality-Related Updates in the CY2019 Final Call Letter. PDF. 2019. Pharmacy Quality Solutions.