Richard Schmitz, MA

The Pharmacy Quality Alliance (PQA) has developed a 3-hour online continuing education (CE) course on “

Measuring Quality to Improve HIV Medication Use

.” Launched September 8, the course complements CE and training programs that are focused on clinical practice.

While clinical training builds skills and knowledge to prevent and treat disease, quality improvement initiatives are essential for analyzing and improving practice performance.

PQA is a national quality organization solely focused on improving medication safety, adherence, and appropriate use, and pharmacotherapy is a cornerstone of successful HIV treatment and prevention.

The PQA course provides an overview of how to build the best HIV treatment regimen and assess treatment outcomes. There is special emphasis on HIV prevention and the role of pre-exposure prophylaxis (PrEP), which is a growing area of pharmacist-provided care.

What distinguishes this course, however, is its focus on quality measurement. Quality measures are the standard for evaluating the care providers provide to patients and address care safety, effectiveness, timeliness, and fairness.

A plethora of quality measures exist for HIV care, including at least 13 medication-related measures. Those measures address:

Treatment, which includes appropriate prescribing, adherence, and monitoring.

Prevention, which includes secondary disease prevention and HIV prophylaxis.

During the course, individuals learn about the features of HIV medication measures, the types of data used to calculate HIV measures, and strategies for improving scores on measures.

Despite a variety of performance metrics used today, gaps exist in measuring medication use quality in HIV treatment and prevention. Developing measures to evaluate HIV prevention is a national priority, especially for measuring PrEP use in high-risk individuals. The course covers the challenges and opportunities for developing these types of measures.

The course’s learning approach is strengthened by a patient case activity and quality improvement project examples. One example is focused on pneumococcal vaccination in HIV-infected patients and a second details strategies to improving a nurse-led adherence project.

The interdisciplinary nature of the course supports team-based approaches to quality improvement. It is nationally accredited for pharmacists, pharmacy technicians, nurses, and physicians and is applicable for all levels of health care professions no matter their experience level working with persons living with HIV.

It can be taken independently or as part of PQA’s 15-hour Medication Use Quality online CE and certificate program. It is available online through 

 (pqa.ceimpact.com). The course costs $60 for PQA members, $90 for non-members

and $40 for those who have completed the certificate program

 provides details and instructions on how to access the program. Information on member pricing, discounts and group purchasing opportunities is available by contacting PQA's education team at 

. This CE activity was supported by an independent medical education grant from Merck & Co.

Richard Schmitz is the Chief Engagement Officer for the 

, a national non-profit quality organization that was initially created by CMS as a public-private partnership in 2006. He oversees PQA’s member and stakeholder engagement efforts, education, communications and meetings. PQA has 250 member organizations across health care.

Articles

PQA course provides an overview of how to build the best HIV treatment regimen and assess treatment outcomes. 

PQA Offers New CE Course on HIV Medication Use Quality

What is the impact of the 3 medication adherence measures used in the 

2021 National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Report

, released in June, estimates that $27–$46.6 billion in health care costs were avoided for Medicare beneficiaries between 2013 and 2018 thanks to improved patient adherence to medications for diabetes, hypertension, and cholesterol.

 (PQA) developed and stewards the 3 Star Ratings measures that evaluate adherence for diabetes medications, hypertension (renin-angiotensin system antagonists), and cholesterol (statins). PQA is the national quality organization dedicated to improving medication safety and appropriate use.

These conditions are major drivers of serious illness, disability, death, and health care costs in the United States. Consider these estimates:

The total estimated 2017 cost of diagnosed diabetes of $327 billion includes $237 billion in direct medical costs and $90 billion in reduced productivity, 

according to the American Diabetes Association

Having high blood cholesterol raises the risk for heart disease, the leading cause of death, and for stroke, the fifth leading cause of death, 

. Nearly 80 million American adults could benefit from cholesterol-lowering medicine.

High blood pressure costs the nation $48.6 billion each year. This total includes the cost of health care services, medications to treat high blood pressure, and loss of productivity from premature death, 

A healthy lifestyle and the use of appropriate medications are key for prevention and control strategies related to these health conditions.

The CMS impact report is strong evidence that medication adherence and PQA’s performance measures play an important role in improving care and controlling costs. The estimated cost savings also counter 

 against Part D’s use of these adherence measures.

 examine individuals’ prescription claims for specific classes of medication therapy, based on the well-accepted proportion of days covered (PDC) methodology. Patients are most likely to achieve clinical benefit from treatment if they have a filled prescription for the medication—or another medication in the same therapeutic class—80% of the time within a measurement year.

PQA’s PDC-based performance measures are classified by CMS as intermediate outcomes measures. PDC measures cannot confirm whether patients take medications as prescribed. However, they provide important insights into how often patients have medication available to take. When you consider the enormous, estimated costs avoided in the CMS impact report, it is reasonable to conclude that these measures effectively evaluate health care activities that correlate with positive health outcomes.

The CMS report provides estimated costs avoided for each of the PQA adherence measures, as well as the increased number of patients who were adherent to the medication from the 2013 baseline. These estimates are for Medicare Advantage (MA) and traditional fee-for-service Medicare beneficiaries with Part D:

Statins: 4.0 million more beneficiaries than expected; costs avoided of 

Diabetes medications: 893,811 more beneficiaries than expected; costs avoided of 

Renin-angiotensin system (RAS) antagonists, including angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers: 3.0 million more beneficiaries than expected; costs avoided of 

PQA medication adherence measures also play a role in addressing health equity. The report notes that disparities in medication adherence narrowed for Black, Hispanic, and low-income MA beneficiaries during this period. That’s good news, but we know more can be done to close adherence gaps.

PQA is committed to addressing health disparities in medication use quality. Both 

 are exploring approaches to address inequities in care, including the stratification of quality measures to highlight disparities and opportunities for improvement. PQA similarly is considering ways to promote health equity through performance measurement. It is part of our developing strategic plan, and we’ll share more on this work in the coming months.

Supporting medication adherence, CMS also 

 that 3.3 million more Part D beneficiaries with complex health needs than expected between 2013-2018 received a comprehensive medication review as a part of medication therapy management. Importantly, “disparities detected in 2013 were no longer evident for MA beneficiaries living in micropolitan, medium metro, small metro, and noncore (rural) areas and for those with middle income.”

Disparities also narrowed for those with dual Medicare-Medicaid eligibility status and for Asian and Hispanic beneficiaries.

This is not the first time CMS has estimated tremendous cost savings thanks to Medicare beneficiaries’ medication adherence. The 

 estimated $4.2-26.9 billion in health care costs avoided from 2011-2015, based on analysis of these same 3 PQA measures. The 2021 report demonstrates that adherence continues to improve, and by association costs avoided are increasing.

Mitigating unnecessary health care costs, such as avoidable hospitalizations and unplanned readmissions, are an important part of delivering high-quality care and ensuring that our care systems remain financially stable and solvent.

Medication Adherence and Value-Based Care

The safe and appropriate use of medicines has great value for everyone in health care. If you’re a physician, hospital or health system, medication adherence supports improved performance on the quality measures for which you are accountable. A 

 concluded that there is a clear relationship between average medication adherence and patient health outcomes as measured at the physician level.

If you’re a pharmacist, this report highlights your role to improve health outcomes for patients and to reduce care costs. Community pharmacist-led interventions have been shown to improve patients' adherence and contribute to better blood pressure control, cholesterol management, chronic obstructive pulmonary disease and asthma control, according to a 2018 

International Journal of Pharmacy Practice

To evaluate pharmacists’ contributions to care, PQA is developing 

 that would be appropriate for accountability in value-based arrangements. Distinct from the claims data-based health plan measures used in Part D that are described above, these measures will use pharmacy system data and other clinical data to evaluate pharmacist-provided care.

A PQA multi-stakeholder expert panel is developing a pharmacy PDC composite measure that parallels the Part D health plan adherence measures for diabetes medications, hypertension and cholesterol. This measure is on track to be developed by the end of 2021. Once assessed against 

standard measure criteria and endorsed by PQA membership

, it will be appropriate for use in plan-pharmacy, value-based agreements.

PQA’s development of pharmacy measures is responsive to 

) to create “standard pharmacy quality measures.” Importantly, PQA’s measures will provide an opportunity to align incentives for health plans and pharmacists. That may drive additional improvement and close gaps in medication adherence and patient outcomes.

Richard Schmitz is the Chief Engagement Officer for the 

CMS reported that 3.3 million more Medicare Part D beneficiaries with complex health needs than expected between 2013-2018 received a comprehensive medication review as a part of medication therapy management

Medication Adherence Measures Help Medicare Beneficiaries Avoid Up to $46.6 Billion in Health Care Costs

Appropriate and safe use of medication is an essential part of high-quality care that improves health care affordability and patient outcomes.

To help health care professionals implement effective quality improvement programs, the Pharmacy Quality Alliance (PQA) has developed Medication Use Quality, an online continuing education (CE) and certificate program.

The program provides advanced training on quality measurement and strategies to improve medication adherence, appropriate use, and safety.

Nurses, pharmacists, pharmacy technicians, and physicians can earn 15 accredited CE hours through the program.

“We believe this is the first continuing education certificate program focused on medication use quality,” said Laura Cranston, RPh, PQA’s chief executive officer.

“We created the program to empower health care professionals to lead quality improvement programs throughout our care system,” she said. “It fills a major gap in continuing and interprofessional education.”

The program features a core curriculum, elective tracks, and practice-based learning. It addresses top issues that will shape quality for years to come, including as follows: • diabetes, heart disease, opioids, and other high-impact areas of care;

Medicaid, Medicare, and federal programs;

Whether a health care professional focuses on internal quality improvement or performancebased payment models, the training provides valuable insights and strategies for delivering better results.

The faculty for the program includes 17 health care quality leaders from the PQA staff and nationally recognized organizations, including Gateway Health, Pharmacy Quality Solutions, Towncrest Pharmacy, UPMC Health Plan, and Walgreens.

“PQA regularly partners with our member associations and CE providers [such as] 

® on educational programs that address best practices in pharmacist-provided services and patient care,” said Loren Kirk, PharmD, PQA’s director of stakeholder engagement. “Our new certificate program focused on medication use quality is a great complement to the other continuing education that is available to pharmacists and quality-interested health care professionals.”

The program, which was unveiled at PQA’s 2020 Annual Meeting in May, is offered online through self-paced modules. For more information, including pricing, visit PQA’s website. Discounts for PQA members and academic institutions and group purchasing options are available. 

A, is senior director of communications at the Pharmacy Quality Alliance in Alexandria, Virginia.

PQA Medication Use Quality. Pharmacy Quality Alliance. Accessed September 25, 2020. https://www.pqaalliance.org/medication- use-quality

Curriculum’s advanced training offers strategies to approve drug adherence, appropriate use, and safety.