PQA Pilots of Pharmacy Measure Concepts Demonstrate Positive Pharmacy Impact on Blood Pressure and Diabetes Clinical Endpoints

The Pharmacy Quality Alliance (PQA) has completed two proof-of-concept pilots that implemented two blood pressure and two hemoglobin A1C pharmacy measure concepts in value-based payment arrangements (VBAs) between payers and pharmacies. The results are detailed in a report issued by PQA today.

PQA Pilots of Pharmacy Measure Concepts Demonstrate Positive Pharmacy Impact on Blood Pressure and Diabetes Clinical Endpoints / Pixel-Shot - stock.adobe.com

The pilot participants were Kroger in collaboration with Kroger Prescription Plans and Arkansas Blue Cross Blue Shield in collaboration with its regional pharmacy networks. More than 100,000 patients and more than 2,000 pharmacists were included in the pilot.

“These pilots demonstrated that pharmacies, working with health plans through value-based arrangements, can positively impact patients’ outcomes for blood pressure and diabetes,” PQA CEO Micah Cost, PharmD, MS, CAE, said. “Structural improvements are needed in how the industry captures and shares data, but the results underscore the importance of standardized measures to advance pharmacist-provided care and pharmacy reimbursement for clinical services.”

Measure improvement from the pilot’s baseline through the one-year endpoint was achieved by both pilot participants across all reportable measures. This demonstrates the positive influence of pharmacies on these measure concepts, which align with biomarker measures for diabetes and hypertension included in the Centers for Medicare & Medicaid Services Universal Foundation and the Medicare Star Ratings program.

Both pilot participants were able to calculate the measure concepts for A1C and blood pressure control and exchange data between payers and pharmacies. However, there were challenges in calculating the measure concepts for A1C and blood pressure improvement because discrete lab values for A1C were not consistently available and not available for blood pressure. As a result, the blood pressure improvement measure was not calculated.

“These pilots represent a successful step forward to developing standardized pharmacy measures,” PQA Vice President of Quality Innovation Lynn Pezzullo, RPh, CPEHR, CPHQ, said. “We have learned much about the dynamics of plan-pharmacy partnerships. These learnings can be leveraged to support the scale, spread and success of payer-pharmacy VBAs that use multistakeholder, consensus-based pharmacy quality measures.”

The pilots were conducted through the PQA Quality Innovation and Research Center and leveraged the center's unique approaches and resources to address challenges in developing, testing and refining complex measure concepts. This work was completed with financial support from the Community Pharmacy Foundation and Kroger Health and in-kind services by PQA.

The pilots and PQA’s other work to develop standard pharmacy measures will be the focus of the 2024 PQA Leadership Summit, November 7-8, in Arlington, Va. The July 18 PQA Quality Forum webinar will include information about these pilots and approaches to implement and scale partnerships with payers for patient care programs in community pharmacies.