Diabetes Q&A with David Nau  8/20/2015

During the September 2015 Diabetes Programs at Retail event, David Nau will hold an educational session during which he will discuss the growing importance of retail pharmacies. In particular, Dr. Nau will describe Medicare Star Ratings as well as the Quality Ratings System for the new state insurance exchanges, and how the quality measures from these programs are now being applied to retail pharmacies.

The following Q&A is a sneak peek at some of the topics that will be discussed:

Why are Quality Ratings important to Retail Pharmacies?
The quality of care related to medications is being driven by CMS wherein Medicare Part C/D plans receive a Star Rating and those ratings have financial implications for the plans. Thus, the plans are evaluating their physician and pharmacy networks using the same quality measures, and are also tying financial implications to a provider’s ratings. A growing set of Medicare plans have created pay-for-performance programs wherein a pharmacy may receive additional pay if the pharmacy scores well on the quality ratings. 

Are there quality ratings of pharmacies outside of Medicare Star Ratings?
Yes. There is a new Quality Rating System (QRS) for the health insurance marketplaces (i.e., exchanges) in each state. Some of the QRS performance measures are the same as the Medicare Star Ratings and are pertinent to medications. For example, medication adherence is measured for the QRS and the Medicare Stars. Some plans are tracking the performance of pharmacies on these quality measures for the QRS and in other lines of business such as Medicaid managed care or employer-sponsored commercial plans. 

How is pharmacy quality evaluated with regards to diabetes care? 
The Medicare Star Ratings for Part D include measures related to diabetes. For example, medication adherence is tracked for all Medicare patients using non-insulin diabetes medications. This measure is triple-weighted when calculating the overall star rating for a plan and thus is tracked by most Medicare plans across all pharmacies. This same quality measure is used within the QRS for insurance marketplaces. CMS is also adopting a new measure that tracks the use of statin medications in Medicare patients with diabetes. 

How can a pharmacy improve its quality ratings?
The first step is to know your ratings. The ratings for pharmacies are available through the EQuIPP platform from Pharmacy Quality Solutions. The majority of Medicare Part D plans are feeding their data into EQuIPP so that pharmacies can track their performance on the Star measures. Once you know where your pharmacy performs well and where you are not performing well, you can focus your efforts on the key deficits. At a minimum, pharmacies should make sure to help patients maintain high levels of adherence to their chronic medications, particularly for patients with Type 2 diabetes. A full gamut of products and services should be deployed for these patients including compliance packaging, reminder calls, and synchronization of refills for all chronic medications. Most importantly, it is crucial to talk to your diabetes patients about their medications every time they enter the pharmacy. 

David Nau

Pharmacy Quality Solutions

Dr. David Nau is President of Pharmacy Quality Solutions, a joint venture of the Pharmacy Quality Alliance (PQA) and CECity. Previously, he served as Senior Director at PQA, and has also held tenured faculty appointments at the University of Michigan and University of Kentucky in addition to serving as Manager of Research Strategies for Humana Pharmacy Solutions.

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