Kellie Dudash, PharmD
Health Economics & Outcomes Research Fellow
Jefferson School of Population Health
The Academy of Managed Care Pharmacy (AMCP) 2010 Educational Conference was held last week in St. Louis, MO. The educational programming clearly reflected key contemporary issues in healthcare reform.
One of the most exciting presentations at the conference was an overview of a project that aims to demonstrate improved medication adherence for health plan members through pharmacy performance reporting and quality metric–focused interventions. The project is a collaboration between Highmark BlueCross BlueShield, Rite Aid Pharmacy, The Pharmacy Quality Alliance (PQA), CECity, and The University of Pittsburgh School of Pharmacy.
The literature indicates that poor medication adherence directly relates to increases in healthcare utilization and costs. Health plans usually tackle this issue by providing physicians with adherence reports for their patients at the population level. This study offers a novel approach by utilizing pharmacists at the point-of-dispensing to target non-adherent patients at the patient level.
The first phase of the project (2008) was rolled out in 50 Rite Aid Pharmacies in Western Pennsylvania. PQA-endorsed adherence measures for certain chronic conditions (heart disease, diabetes) were calculated for health plan members using Highmark claims data. CECity’s Lifetime™ platform translated the data into user-friendly electronic performance reports for Rite Aid pharmacists. The pharmacists could then compare the members’ adherence rates over time to those in their region and in all participating pharmacies.
Now that a system is in place to measure adherence in health plan members, phase two of the project (2010) will measure the impact of a psychosocial intervention on member adherence. Pharmacists in the intervention group will be trained in motivational interviewing techniques that will be used to motivate the non-adherent members. The primary outcome measured will be an increase in member adherence as measured by the PQA-endorsed adherence measures. Secondary outcomes include overall healthcare utilization calculated using member pharmacy and medical claims as well as member satisfaction with pharmacy services. The outcomes measured will be compared to health plan members in a control group in Central Pennsylvania who did not receive the intervention.
Currently, the data is only available at the pharmacy level. If they are able to measure data at the individual pharmacist level, exciting future directions for this project could include consumer reporting of pharmacist services and incentive reimbursement programs (pay-for-performance) for pharmacists.
As a profession, pharmacists have traditionally struggled with demonstrating the value of the cognitive services we offer. Retail pharmacists in particular are primarily rewarded based on prescription volume. It seems inappropriate to equate our professional value with hitting a target number that does not adequately account for the patient care services that go into each prescription.
I think most store managers would be open to rewarding pharmacists for cognitive services; but without easy to understand measures, the value of these services is consequently ignored. By creating a system to concretely measure the impact of pharmacists on improving patient outcomes, this pilot project is a step in the right direction.