May 23, 2006
New Study Proposes Robust Quality Measurement for Medicare Prescription Drug Plans
Part D Benefit Provides Opportunity to Measure, Track and Improve
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WASHINGTON and ALEXANDRIA, Va. -- Two nationally respected health care organizations released a white paper today that outlines the need for quality measurement activities in the Medicare Part D prescription drug benefit. The paper urges the Centers for Medicare & Medicaid Services (CMS) to use newly available pharmacy claims data to measure the quality and efficiency of Part D plans, and to use the results to improve the quality of care for all Medicare beneficiaries.
The establishment of a prescription drug benefit for Medicare beneficiaries represents a singular opportunity for quality assessment and improvement. Analysis of claims data from Part D plans would extend the benefits of measurement – including public reporting and the incentive and framework for improvement – to the delivery of medication therapies.
The National Committee for Quality Assurance (NCQA) and the Academy of Managed Care Pharmacy (AMCP) co-commissioned the study to call attention to the opportunity available to CMS and Part D plans to accumulate, analyze and evaluate pharmacy claims data.
"Medicare’s prescription drug benefit holds great promise for improving seniors’ lives by increasing access to medications,” said NCQA President Margaret E. O’Kane. “But we need to make sure that the promise of the benefit isn’t undercut by the possibility of medication errors. This paper highlights a great opportunity to collect and report data that can lead to improvements in appropriate medication management for seniors."
The paper, Developing a Robust Quality Measurement Approach for Medicare Part D, recommends clinical quality measurement activities in which all Part D plans, whether stand-alone drug plans or Medicare Advantage plans, can engage in the near term using pharmacy claim data. More complex measures that require both medical and pharmacy claim data will be possible at a point in the future when CMS and the Part D plans are able to link Part A, Part B and Part D data.
Judith Cahill, executive director of AMCP, said "Pharmacists play a significant role in health care delivery; an effective pharmacist goes a long way towards enhancement of patient care. CMS can build on the best practices of commercial health plans and pharmacy benefit management companies and adapt them to meet the particular characteristics of the Medicare pharmacy benefit."
The study, available for download at http://www.ncqa.org/ and http://www.amcp.org/, recommends the formation of a multi-stakeholder group to consider the implications of the white paper and the development of an implementation plan that recognizes the complex relationship between Part D plans and providers and establishes best practices for effective use of pharmacy data to measure and improve patient care.
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS®, the tool the nation’s health plans use to measure and report on their performance. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.
The Academy of Managed Care Pharmacy (AMCP) is a national professional association of pharmacists and other health care practitioners who serve society by the application of sound medication management principles and strategies to achieve positive patient outcomes. The Academy's 4,800 members develop and provide a diversified range of clinical, educational and business management services and strategies on behalf of the more than 200 million Americans covered by a managed care pharmacy benefit. More news and information about AMCP can be obtained on its website, at http://www.amcp.org/.